Use of Home-Obtained Vaginal Swabs to Facilitate Rescreening for Chlamydia trachomatis Infections: Two Randomized Controlled Trials

Xu, Fujie MD, PhD; Stoner, Bradley P. MD, PhD; Taylor, Stephanie N. MD; Mena, Leandro MD, MPH; Tian, Lin H. MD, MS; Papp, John PhD; Hutchins, Kathleen BS; Martin, David H. MD; Markowitz, Lauri E. MD

doi: 10.1097/AOG.0b013e3182246a83
Original Research

OBJECTIVE: To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase rescreening rates in comparison with clinic-based rescreening, and to identify subgroups in which rescreening could be enhanced using self-obtained vaginal swabs.

METHODS: Two randomized trials were conducted: one with enrollment in sexually transmitted disease (STD) clinics and the other in family planning clinics. Study participants were recruited from STD (n=880) and family planning clinics (n=412) in three cities. Females aged 16 years or older who were treated for Chlamydia infection were randomly assigned to the home group (swab collection kits mailed to home) or the clinic group (made clinic appointments) for rescreening at 3 months after treatment, with reminder calls about 2 weeks before the scheduled rescreening date.

RESULTS: Groups were similar with respect to age and other demographic characteristics. Women assigned to the home group had higher rescreening rates than those in the clinic group. In STD clinics, rescreening rates were 26.7% (home) compared with 19.1% (clinic) (P=.01). In family planning clinics, rescreening rates were 40.8% (home) compared with 20.7% (clinic) (P<.001). Among women reached by reminder calls, rescreening rates were also significantly higher in the home groups: 43.5% compared with 33.0% in STD clinic participants and 59.2% compared with 37.8% in family planning clinic participants (both P<.05). The rates of reinfection ranged from 12.9% to 19.4%, and the differences by group were not statistically significant (P≥.3).

CONCLUSION: In STD and family planning clinics, use of home-based, self-obtained vaginal swabs resulted in significant increases in rescreening rates compared with rescreening in the clinic. Home-based specimen collection can be an alternative to clinic-based rescreening for Chlamydia infection in women.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT 00132457.

LEVEL OF EVIDENCE: I

Two randomized trials show that use of home-obtained vaginal swabs results in a significant increase in rescreening rates compared with rescreening in the clinic.

From the Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia; the Departments of Anthropology and Internal Medicine, Washington University, St. Louis, Missouri; School of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and the University of Mississippi Medical Center, Crossroads Clinics, Mississippi State Department of Health, Jackson, Mississippi.

Funded by Centers for Disease Control and Prevention.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Corresponding author: Fujie Xu, MD, PhD, Mailstop E-02, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333; e-mail: fax1@cdc.gov.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists.