Urine Screening for Chlamydia trachomatis During Pregnancy

Roberts, Scott W.; Sheffield, Jeanne S.; McIntire, Don D.; Alexander, J.

doi:10.1097/aog.0b013e3182107d47

Cited by 10 publications

(10 citation statements)

References 6 publications

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“…Eight studies (n = 6182) compared self-collected urine to clinician-collected cervical samples [ 17 , 37 , 38 , 41 , 42 , 49 , 50 , 55 ]. The pooled sensitivity was 0.87 (95% CI 0.81–0.91) and specificity was 0.99 (95% CI 0.98–1.00).…”

Section: Resultsmentioning

confidence: 99%

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

et al. 2015

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BackgroundThe increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays.MethodsThe hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures.FindingsWe included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00).ConclusionThe sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who r...

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Section: Resultsmentioning

confidence: 99%

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

et al. 2015

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“…Therefore, vaginal swabs and urine should only be analysed through molecular amplification methods. These distinct chlamydial loads probably explain the lower sensitivity found by some authors when using first-void urine rather than vaginal or endocervical swabs (14), although this difference has not been found in all studies (75). The most recent NAATs use specific primers and probes that target two cryptic plasmid fragments or a fragment of the cryptic plasmid and another fragment of the ompA gene.…”

Section: Microbiological Diagnosismentioning

confidence: 91%

Chlamydia trachomatis Infection and Reproductive Health Outcomes in Women

Piñeiro¹,

Cilla²

2012

Chlamydia

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“…This is a novel finding for self-sampled HPV screening in pregnancy and might have clinical importance, since during routine low-risk antenatal care, patients are providing urine (urinary tract infection) or vaginal (streptococcal screening) samples at different times, and there have also been suggestions of chlamydial screening in pregnancy. A large cross-sectional study showed that urine sampling for Chlamydia trachomatis is equivalent to endocervical sampling in pregnancy [77]. hr-HPV and Chlamydia cotesting in urine might be a future cost-effective approach.…”

Section: • Concordance Of Vaginal and Urine Samplesmentioning

confidence: 98%

Applicability of Self-Obtained urine and Vaginal Samples for HPV-16, -18, -31 and -45 Cervical Cancer Screening in Pregnancy: A Pilot Cross-Sectional Studya

et al. 2014

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Aim: To conduct a pilot cross-sectional study to evaluate the rates of detection of four common high-risk HPV (hr-HPV) types using first-void urine paired with vaginal self-obtained samples in a nonvaccinated population of pregnant women. We also aimed to compare these results with a matched nonpregnant group in order to test the applicability of self-sampled hr-HPV cervical cancer screening during antenatal visits. Materials & methods: Samples from 550 pregnant women were subjected to hr-HPV-16, -18, -31 and -45 type detection by inhouse PCR and compared with 250 paired urine, vaginal and cervical samples from an age-matched cohort of nonpregnant women. Results: Comparing overall hr-HPV prevalence in urine and vaginal samples between pregnant (15 out of 550; 2.7%) and nonpregnant women (eight out of 250; 3.2%) for each HPV type revealed no significant differences. All paired urine/vaginal samples were both positive for the same type of hr-HPV and there was no positive urine sample with the other samples being negative. Conclusion: hr-HPV detection in pregnant women using self-obtained urine and vaginal samples seems to be a feasible cervical cancer screening method.Although largely preventable, cervical cancer is a common cancer-related cause of death among women worldwide [1]. The widespread screening for cervical cancer by Pap smear has led to a substantial decrease in the prevalence of the disease, but the majority of cervical cancer cases (60%) are still associated with absence or deficiency of screening [2,3,4].However, cytology by Pap smears or liquid-based cytology requires a pelvic examination, a procedure that is invasive and uncomfortable for the patient, time consuming for healthcare providers, cannot be carried out easily in resource-poor settings [5,6] and may also conflict with the personal beliefs of some women [7]. In addition, it is reported to be associated with relatively low sensitivity [8,9].HPV is now well established as the necessary cause of cervical cancer [10,11]. High-risk (hr)-HPV types are associated with over 99% of invasive cervical cancers and detection of hr-HPV DNA is considered the primary screening method [12][13][14][15][16][17][18]. Pooled analysis of four randomized controlled trials (SWEDESCREEN [19], POBASCAM [20,21], ARTISTIC [22] and NTCC [23]) of HPV-based cervical screening versus conventional cytology showed a significant reduction in invasive cervical cancers in women who had HPV-based screening, providing 60-70% greater protection against invasive cervical carcinomas [24]. For reprint orders, please contact: reprints@futuremedicine.com 386 future science group RESEARCh ARTiClE Mantzana, Pournaras, Skentou et al. Future Virol. (2014) 9(4)However, the detection of hr-HPV DNA with the standard cervical sample also requires a gynecological examination and a physician-obtained cervical sample. Therefore, the existing cervical screening program would benefit from the introduction of noninvasive self-sampling methods, as they are more friendly and acceptable, thus increa...

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Urine Screening for Chlamydia trachomatis During Pregnancy

Cited by 10 publications

References 6 publications

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

Chlamydia trachomatis Infection and Reproductive Health Outcomes in Women

Applicability of Self-Obtained urine and Vaginal Samples for HPV-16, -18, -31 and -45 Cervical Cancer Screening in Pregnancy: A Pilot Cross-Sectional Studya

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