Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men

Abstract

Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…There is evidence to suggest that self-collected pharyngeal and rectal swabs perform as well as clinician-taken swabs from both sites, although published studies are not powered to exclude a difference in performance. Self-taken swabs are highly acceptable to MSM (117)(118)(119).…”

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

“…Seven studies were identified that evaluated CT detection from self-collected rectal swabs [31,32,38,[40][41][42][43], and acceptability of self-collecting a rectal swab was evaluated in 5 studies [34,[40][41][42][43]. The Sexton et al study discussed above also evaluated patient-vs provider-collected rectal swabs and found that 35 (12.7%) subjects were classified as having rectal CT infection, with all 35 CT-positive subjects identified by patient-collected rectal swab vs only 32 identified by provider-collected rectal swab [31].…”

“…These 3 studies reported a slightly higher sensitivity for the self-collected rectal swab than the earlier study by Moncada et al that reported a sensitivity of 82% for self-collected rectal swabs tested by TMA [38], and all found comparable NAAT performance on self-vs provider-collected rectal swabs. Two small prospective studies by Dodge et al evaluated CT detection by PCR on self-collected rectal swabs from men offered the swab at a variety of clinic-and field/community-based venues [41,42]. One study evaluated 75 MSM and found that of the 62 MSM who self-collected a rectal swab and agreed to have CT testing performed, 5 (8%) were CT positive [41].…”

“…Two small prospective studies by Dodge et al evaluated CT detection by PCR on self-collected rectal swabs from men offered the swab at a variety of clinic-and field/community-based venues [41,42]. One study evaluated 75 MSM and found that of the 62 MSM who self-collected a rectal swab and agreed to have CT testing performed, 5 (8%) were CT positive [41]. Similarly, the other study evaluated 75 bisexual men and of 58 men who collected a rectal swab and agreed to testing, and 6 (10.3%) were CT positive [42].…”

“…Neither study evaluated a provider-collected swab. Both studies evaluated feasibility; 1 study reported that all subjects providing rectal swabs would agree to have rectal testing in the future and given the option, most would prefer self-collection at home [41], whereas the other study found that subjects collecting swabs reported acceptability and comfort with the process, yet reported privacy as the main concern [42]. The Wayal et al study evaluated feasibility and acceptability of MSM self-collecting rectal swabs, and the results were discussed above [34].…”