Vaginal Swab vs Urine for Detection ofChlamydia trachomatis, Neisseria gonorrhoeae, andTrichomonas vaginalis:A Meta-Analysis

Abstract

PURPOSE Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the 2 most frequently reported notifiable sexually transmitted infections (STIs) in the United States, and Trichomonas vaginalis (TV), although not a notifiable disease, is the most common curable non-viral STI worldwide. Women bear a disproportionate burden of these infections and testing is necessary to identify infections. Although vaginal swabs are the recommended sample type, the specimen most often used among women is urine. The objective of this meta-analysis was to assess the diagnostic sensitivity of commercially available assays for vaginal swabs vs urine specimens from women.METHODS A systematic search of multiple databases from 1995 through 2021 identified studies that (1) evaluated commercially available assays, (2) presented data for women, (3) included data obtained from the same assay on both a urine specimen and a vaginal swab from the same patient, (4) used a reference standard, and (5) were published in English. We calculated pooled estimates for sensitivity and the corresponding 95% CIs for each pathogen as well as odds ratios for any difference in performance. RESULTSWe identified 28 eligible articles with 30 comparisons for CT, 16 comparisons for NG, and 9 comparisons for TV. Pooled sensitivity estimates for vaginal swabs and urine, respectively, were 94.1% and 86.9% for CT, 96.5% and 90.7% for NG, and 98.0% and 95.1% for TV (all P values <.001).CONCLUSIONS Evidence from this analysis supports the Centers for Disease Control and Prevention's recommendation that vaginal swabs are the optimal sample type for women being tested for chlamydia, gonorrhea, and/or trichomoniasis.

Detection of Chlamydia psittaci in the Genital Tract of Horses and in Environmental Samples: A Pilot Study in Sardinia

“…The results of this pilot study revealed that prevalence of C. psittaci in vaginal swabs was significantly higher compared to uterine swabs. These results are consistent with previous studies [ 38 , 39 ], in which it was confirmed that vaginal swabs are the more appropriate specimens for diagnosis of genital tract infection with Chlamydia species in horses since this technique allows a greater quantity of mucus and cells to be collected and is less dependent on the operator’s skill [ 38 ].…”

Prevalence of Curable Sexually Transmitted Infections in a Population-Representative Sample of Young Adults in a High HIV Incidence Area in South Africa

“…Thus, STI prevalence in this cohort cannot be stratified by HIV status; however, other studies have found a higher prevalence of curable STIs among people living with HIV than those without HIV, particularly among women 23 . Furthermore, approximately one-quarter of female participants provided urine specimens, which have a slightly lower sensitivity than vaginal swab specimens, 30 and may have led to an underestimation of STI prevalence among female participants. Finally, several participants had invalid STI test results; however, this was a small percentage of the total cohort (<2%).…”

Screening for Chlamydia and Gonorrhea in Youth Correctional Facilities, Utah, USA

“…Vaginal swab specimens offer higher sensitivity compared with urine screening in detecting both C. trachomatis and N. gonorrhoeae, with sensitivities reaching 94.1% (C. trachomatis) and 96.5% (N. gonorrhoeae) for vaginal swab specimens and 86.9% (C. trachomatis) and 90.7% (N. gonorrhoeae) for urine specimens. (20) vaginal screening for C. trachomatis and N. gonorrhoeae to female youth entering Utah correctional facilities, as well as to offer intake screening for trichomoniasis to female youth and screening for HIV in both sexes. A final limitation was the unknown treatment completion for youth who were released before receiving positive results.…”