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Three Part Question

In [adult females with gonorrhea or chlamydia cervical infections], are [self-obtained vaginal swabs compared to clinician-taken swabs], as [accurate in detecting infection in the emergency department].

Clinical Scenario

A 25 year old female presents to the emergency department with a complaint of yellow vaginal discharge for the past week after having unprotected sex. She is afebrile with normal vital signs and has no history of sexually transmitted disease (STD) in the past. You tell her that vaginal swabs need to obtained to test for gonorrhea and chlamydia and she asks if a speculum exam is really necessary for this test.

Search Strategy

Medline 1966-04/18 using PubMed, CINAHL, Cochrane Library (2018), and Embase
[(exp chlamydia OR exp gonorrhea) AND (exp self-collected OR exp patient collected OR exp vaginal swabs)]. Limit to humans and English language.

Search Outcome

317 studies were identified; one systematic review addressed the clinical question. This review, published in 2015, considered 21 clinical trials for inclusion. Since 2015, there has been one prospective study of self-taken swabs versus clinician taken swab cultures for diagnosing gonorrhea in women.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Lunny C, et al. 2015 Canada	21 studies were included, with 6 of these studies comparing clinician to patient vaginal swabs	Systematic review	Sensitivity and specificity of self-collected vaginal swabs compared to clinician collected cervical swabs for chlamydia and gonorrhea	Chlamydia testing: 92% sensitivity and of 98% specificity. Gonorrhea testing: 92% sensitivity and of 99% specificity.	Clinician-collected specimens were used as the gold reference standard which assumes 100% accuracy; excluded unpublished research.
Stewart C, et al 2012 England	3859 women aged 16 and older presenting for new visit to Sexual Health Center	Prospective cross-sectional study	Positive confirmation of gonorrhea	Sensitivity was 96% for physician-collected and 99% for self-collected.	Single center study; no randomization of swab order; no testing for chlamydia

Comment(s)

Emergency departments (EDs) are an important site for the diagnosis and treatment of STDs, particularly among those with higher behavioral/demographic risks. Few studies have specifically looked at the validity of self-taken vulvovaginal swabs for the diagnosis of chlamydia and gonorrhea, and these studies were performed in outpatient settings. However, preliminary results demonstrate that self-taken vulvovaginal swabs are as accurate as clinician endocervical swabs for the detection of chlamydia and/or gonorrhea. This would mean that women would not require a genital examination for STD detection, with reduction in health care costs, equipment use, and ED turnaround times. Patient instructions on how to self-collect vulvovaginal swabs are now available on the internet.

Editor Comment

JB

Clinical Bottom Line

The sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab self-collection for noninvasive chlamydia and gonorrhea testing.

References

1. Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, Krajden M, Ogilvie G. Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis PLoS One 2015 Jul 13;10(7):e0132776
2. Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study BMJ 2012 Dec 12;345:e8107