Tools for Practice

#208 Vaginal Self Swabs – Simple and Sensitive for STIs

What is the most sensitive way to test for chlamydia and gonorrhea?

Self-collected vaginal swabs (SCVSappear more sensitive in diagnosing chlamydia and gonorrhea than health professional collected endocervical swabs and first catch urine (FCU). Endocervical swabs and FCU testing may miss up to 10% of STIs in womenSCVS (when pelvic exam not required) is recommended in women and FCU in men.

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  • SCVS versuendocervical swab: 
    • 3,973 women (with and without symptoms) in sexual health centre had SCVS followed by physician endocervical swab:1 
      • SCVS statistically significantly increased sensitivity: 97% versus 88%. 
        • Endocervical swab missed 1 in 11 cases of chlamydia. 
    • SCVS and endocervical swabs had similar sensitivities (99% and 96%) for gonorrhea.2 
  • SCVS versus FCU and/or endocervical swab: 
    • 1,464 symptomatic and asymptomatic women aprimary/secondary care clinics, all collected SCVSphysician vaginal, or endocervical swabs and FCU.3 
      • Physician and SCVS: Similar sensitivity (>95%) for gonorrhea and chlamydia. 
      • SCVS versus FCU: SCVS identified statistically significantly more patients with chlamydia (196 versus 171).  
    • 318 women (172 with chlamydia):4 
      • FCU had statistically significant lower sensitivity (88%) compared to endocervical and SCVS (~97%).
    • 1,654 men and women (164 with chlamydia):5 
      • Endocervical swab statistically significantly more sensitive (99%) than FCU (85%). 
        • SCVS (95%) not different than either. 
      • In men, no significant difference between urethral swab or FCU. 
  • Systematic review (21 studies) reported no difference in sensitivity of FCU (87%) versus SCVS (92%).6 
    • Limitations: Compared to endocervical specimens, which are not 100% sensitive.6  
  • No gold standard for chlamydia and gonorrhoea detection, limiting evaluation of new diagnostic tests.7  
  • Combination swab specificities in above studies were consistently 99-100%.1-3 
  • Patients find SCVS “easy” to perform (88%) and prefer home completion.8 
  • Patients randomized to home testing (swabs mailed to their home) are twice as likely to complete the test (~60% versus 30%).9,10  
  • Nucleic acid amplification test swab is recommended. Specimens can be stored at room temperature and must be processed <60 days of collection. 
  • Guidelines recommend:11  
    • SCVS when a pelvic exam is not otherwise indicated. 
    • FCU for men. 

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  • Christina Korownyk MD CCFP
  • Michael R Kolber BSc MD CCFP MSc

1. Schoeman SA, Stewart CM, Booth RA, et al. BMJ. 2012 Dec 12; 345:e8013.

2. Stewart CM, Schoeman SA, Booth RA, et al. BMJ. 2012 Dec 12; 345:e8107.

3. Schachter J, Chernesky MA, Willis DE, et al. Sex Transm Dis. 2005 Dec; 32(12):725-8.

4. Falk L, Coble BI, Mjörnberg PA, et al. Int J STD AIDS. 2010 Apr; 21(4):283-7.

5. Michel CE, Sonnex C, Carne CA, et al. J Clin Microbiol. 2007 May; 45(5):1395-402.

6. Lunny C, Taylor D, Hoang L, et al. PLoS One. 2015 Jul 13; 10(7):e0132776.

7. Miller WC. Epidemiology. 2012 Jan; 23(1):83-5.

8. Paudyal P, Llewellyn C, Lau J, et al. PLoS One. 2015 Apr 24; 10(4):e0124310.

9. Wilson E, Free C, Morris TP, et al. PLoS Med. 2017 Dec 27; 14(12):e1002479.

10. Graseck AS, Secura GM, Allsworth JE, et al. Obstet Gynecol. 2010 Apr; 115(4):745-52.

11. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2014 Mar 14; 63(RR-02):1-19.

Authors do not have any conflicts of interest to declare.