Home Sampling versus Conventional Swab Sampling for Screening of<i>Chlamydia trachomatis</i>in Women: A Cluster‐Randomized 1‐Year Follow‐up Study

Østergaard, Lars; Andersen, Berit; Frimodt‐Møller, Niels; Olesen, Frede

doi:10.1086/318139

Cited by 160 publications

(154 citation statements)

References 33 publications

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“…The use of SCVSs might also help to increase the acceptability of screening programs for women, given that recent studies have shown that these samples are highly acceptable and perform as well as, if not better than, FVU specimens and endocervical swabs (13,26). Evidence in support of screening based on home sampling with SCVSs in women and FVU specimens in men has been presented previously (2,20), and our findings support the choice of these specimen types. In addition, vaginal swab specimens are easier to handle during collection and transport and require fewer steps to process compared to FVU specimens.…”

Section: Fig 2 Organism Load In Matched Specimens From Men and Womesupporting

confidence: 75%

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

et al. 2007

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Urethral and endocervical swabs and self-collected vaginal swabs (SCVSs) and urine specimens are all used as samples for diagnosis of urogenital infection with Chlamydia trachomatis. We have now determined chlamydial organism load in matched specimens from different anatomic sites and examined its relation to clinical signs and symptoms in men and women. Organism load was measured with assays based on the ligase chain reaction or real-time PCR analysis. The mean organism loads in 58 infected men were 1,200 and 821 elementary bodies (EBs) per 100 l of sample for first-void urine (FVU) and urethral swabs, respectively (P > 0.05). Organism load in FVU samples or urethral swabs was positively associated with symptoms (P < 0.01) and clinical signs (P < 0.01) in men. The mean organism loads in 73 infected women were 2,231, 773, 162, and 47 EBs/100 l for endocervical swabs, SCVSs, urethral swabs, and FVU samples, respectively (P < 0.001 for each comparison). Only the presence of multiple symptoms or clinical signs was associated with organism load in women. These results show that FVU is a suitable noninvasive sample type for men, given the fact that its chlamydial load did not differ significantly from that of urethral swabs. Given their higher organism load compared with FVU, SCVSs are the preferred noninvasive sample type for women.Urogenital infection with Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection (STI) and continues to be a major public health problem worldwide (4, 35). Given that most chlamydial infections are asymptomatic in both men and women, they often remain undiagnosed and untreated and therefore provide a reservoir for the disease (33). Infection of the upper genital tract may lead to complications, such as epididymitis in men and pelvic inflammatory disease in women. The inflammation and subsequent tissue scarring associated with the latter can lead to more serious sequelae (4).Effective control of chlamydial infection within a population requires early diagnosis and prompt treatment of asymptomatic individuals (28). Targeted and regular screening is also recommended for people in high-risk groups or with a past history of genital chlamydial infection (14). The most common sites of infection in women are the cervix and urethra. Infected cells are shed from the endocervix into the vagina and are present in vaginal secretions. Infected epithelial cells from the urethra and the associated C. trachomatis elementary bodies (EBs) can also be detected in first-void urine (FVU) (3, 16). Potentially suitable clinical specimens for detection of chlamydial infection in women thus include urethral, vaginal, and endocervical swabs, self-inserted tampons, and FVU samples (3, 12). For screening programs, noninvasive specimens, such as vaginal swabs, tampons, and FVU, are preferable to invasive urethral and endocervical swabs because they overcome several barriers associated with the traditional diagnostic pathway (5, 11). Sensitivity of C. trachomatis detection with vag...

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Section: Fig 2 Organism Load In Matched Specimens From Men and Womesupporting

confidence: 75%

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

et al. 2007

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“…95% CI 0·22 to 0·83), 13,93 suggesting the overall result might overestimate the protective 319 effects of a screening test. Another completed cluster RCT will report on the association of up 320 to four rounds of chlamydia testing on the incidence of PID measured in hospitals and 321 primary care clinics.…”

mentioning

confidence: 99%

Sexually transmitted infections: challenges ahead

Unemo

Bradshaw

Hocking

et al. 2017

The Lancet Infectious Diseases

565

469

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“…Equally, a randomised study with 9-year follow-up in women aged 21-23 years performed in Denmark found no differences between screened and non-screened women in the rates of PID and long-term risk of reproductive complications as the outcome (5). In contrast, two randomized trials comparing chlamydia screening in young women with a control group not invited for testing found a 50% reduction in PID over the subsequent year (64,82). Finally, in another randomised trial, limited evidence was observed suggesting that screening for chlamydia reduces PID rates: 10% of asymptomatic infected women not treated developed PID within a year, versus 2% of screened and treated women (63).…”

Section: Preventionmentioning

confidence: 95%