Self-collected vaginal swabs for the detection of multiple sexually transmitted infections in adolescent girls

Abstract

Objective: To evaluate the use of self-collected vaginal swabs to test for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis, and to describe the acceptability of this technique to adolescents.

Design: Comparison of a new protocol for sexually transmitted infection (STI) testing with the current standard of care, using the same subjects. Survey of attitudes regarding the self-collection technique.

Setting: A juvenile correctional facility in western Pennsylvania.

Participants: Convenience sample of 133 detainees, 12-17 years of age.

Intervention: Girls were invited to undergo STI screening using a self-collected vaginal swab. Polymerase chain reaction was used to test this specimen for each of the above three infections. Pelvic exams and endocervical testing were performed at the discretion of the physician performing the intake physical, independent of the study.

Main outcome measures: The number of infections diagnosed using the self-testing protocol, compared to the number diagnosed using standard practices; acceptability of the self-collection technique.

Results: Twenty-four percent of sexually active subjects had one or more infections diagnosed by self-testing: 11.3% had C. trachomatis, 8.5% had N. gonorrhoeae, and 11.7% had T. vaginalis. Only 30% of subjects with infections had pelvic exams while detained; therefore 70% of girls with infections would have been missed in the absence of the self-testing option. The self-collection technique was acceptable to 95% of subjects.

Conclusions: STI testing using self-collected vaginal specimens is highly acceptable to adolescent girls, and can dramatically increase the detection rate for these three treatable infections when pelvic exams are not performed.