Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men

Abstract

The coronavirus (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was primarily used for genital and anorectal infections with only limited studies on the performance of self-collected oropharyngeal swabs for oropharyngeal STIs. Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhoea and chlamydia screening on March 16, 2020 to reduce healthcare worker risk during the COVID-19 pandemic. We compared the proportion of valid and positive samples for gonorrhoea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician-collected period between January 20 and March 15, 2020; and the self-collected period between March 16 and May 8, 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for N. gonorrhoeae was higher in the self-collected period (1.6% [24/1,497]) compared to the clinician-collected period (0.9% [23/2,600]) (p=0.038) but did not differ for the detection of C. trachomatis. The positivity of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio (PR) 1.09; 95% CI: 0.87 to 1.37; p=0.435) and oropharyngeal C. trachomatis (adjusted PR 0.84; 95% CI: 0.51 to 1.39; p=0.504) did not differ between the two periods. Self-collected oropharyngeal swabs for detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and importantly reduce healthcare worker exposure to respiratory infection.

Sexual health service adaptations to the coronavirus disease 2019 (COVID‐19) pandemic in Australia: a nationwide online survey

“…The change to self‐collection of oropharyngeal swabs in clinics across Australia is unlikely to impact diagnoses of Chlamydia trachomatis and Neisseria gonorrhoeae given a previous study in MSM showed no difference in positivity after self‐collection in either infection 19 . However, there was an increase in the proportion of indeterminate results for N. gonorrhoeae but not C .…”

“…The change to self‐collection of oropharyngeal swabs in clinics across Australia is unlikely to impact diagnoses of Chlamydia trachomatis and Neisseria gonorrhoeae given a previous study in MSM showed no difference in positivity after self‐collection in either infection. 19 However, there was an increase in the proportion of indeterminate results for N. gonorrhoeae but not C . trachomatis during the self‐collection period compared to clinician‐collected (1.6% [24/1,497] versus 0.9% [23/2,600]; p=0.038), 19 perhaps due to men not collecting sample thoroughly enough which may potentially translate to an increase in extra clinic visits for repeat tests nationwide for oropharyngeal gonorrhoea.…”

“…However, there was an increase in the proportion of indeterminate results for N. gonorrhoeae but not C . trachomatis during the self‐collection period compared to clinician‐collected (1.6% [24/1,497] versus 0.9% [23/2,600]; p=0.038), 19 perhaps due to men not collecting sample thoroughly enough which may potentially translate to an increase in extra clinic visits for repeat tests nationwide for oropharyngeal gonorrhoea. Further studies will be required to minimise indeterminate results from self‐collected oropharyngeal swabs.…”

Kissing, fellatio, and analingus as risk factors for oropharyngeal gonorrhoea in men who have sex with men: A cross-sectional study

“… 22 , 23 Fifth, we changed clinician-collected oropharyngeal swabs to self-collected oropharyngeal swabs in March 2020 to minimise the exposure to SARS-CoV-2 among healthcare workers during the COVID-19 pandemic; however, there was no significant difference in oropharyngeal gonorrhoea positivity. 29 …”

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

“…These assays diagnose CT, including LGV, detecting all serovars. NAATs are highly sensitive for detecting CT-DNA/RNA in first void urine and self-taken vaginal, rectal, and pharyngeal swabs; self-collection is well and widely accepted in women and in MSM as shown in prospective and retrospective cohort studies [44][45][46][47][48]. A randomized clinical trial (RCT) in women and MSM showed good concordance between clinician-and self-taken pharyngeal and rectal swabs, with similarly high diagnostic accuracy [49].…”