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Swab-yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 1. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Clinician-taken vs Self-taken Rectal and Pharyngeal Samples for the Diagnosis of Gonorrhea and Chlamydia
- Source :
- Clinical Infectious Diseases; 11/1/2021, Vol. 73 Issue 9, pe3172-e3180, 9p
- Publication Year :
- 2021
-
Abstract
- Background Urogenital testing misses extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Extragenital self-sampling is frequently undertaken despite no robust randomized, controlled trial evidence of efficacy. We compared clinician-taken rectal and pharyngeal samples with self-taken samples for diagnostic accuracy and cost in men who have sex with men (MSM) and in females. Methods This was a prospective convenience sample from a UK sexual health clinic. We randomized the order of clinician- and self-taken samples from the pharynx and rectum, plus first catch urine (MSM) and vulvovaginal swabs (females), for NG/CT detection. Results Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 9.4% infected females and 67.3% MSM were urogenital-negative. A total of 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx); 13.1% infected females and 71.8% MSM were urogenital-negative. Sexual history did not identify those with rectal infections. There was no difference in diagnostic accuracy between clinician- and self-taken samples from the rectum or pharynx. Clinicians took swabs more quickly than participants, so costs were lower. However, in asymptomatic people, nonqualified clinicians would oversee self-swabbing making these costs lower. Conclusions There was no difference in the diagnostic accuracy of clinician-taken compared with self-taken extragenital samples. Sexual history did not identify those with rectal infections, so individuals should have extragenital clinician- or self-taken samples. Clinician-taken swabs cost less than self-taken swabs; however, in asymptomatic people or those who perform home testing, the costs would be lower than for clinician-taken swabs. Clinical Trials Registration NCT02371109. [ABSTRACT FROM AUTHOR]
- Subjects :
- GONORRHEA diagnosis
CHLAMYDIA infection diagnosis
HOME diagnostic tests
PHARYNX
VULVA
MEDICAL care costs
WOMEN
RECTUM
VAGINA
RANDOMIZED controlled trials
COST effectiveness
NEISSERIA
DESCRIPTIVE statistics
COLLECTION & preservation of biological specimens
MEN who have sex with men
STATISTICAL sampling
CHLAMYDIA trachomatis
PATIENT self-monitoring
LONGITUDINAL method
SEXUAL health
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 73
- Issue :
- 9
- Database :
- Complementary Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 153439864
- Full Text :
- https://doi.org/10.1093/cid/ciaa1266