To the Editor:
The data on acceptability of self-collected vaginal swabs for STD screening, as published by H. C. Wiesenfeld and colleagues in the June 2001 issue of Sexually Transmitted Diseases (28:321–5), open up new perspectives for implementing large-scale screening in different populations. Our ongoing research on acceptability of self-sampling in general practice confirms their promising results.
We are investigating, in a general practice setting in Antwerp, Belgium, the attitude of patients and doctors toward self-screening for Chlamydia trachomatis. Forty-eight general practitioners—27 working in the inner city and 21 in suburban and rural practices—are involved in the study. Women younger than age 35 years are offered free testing when visiting a general practitioner for a pill prescription, contraception advice, MAP, or any gynecological problem. An earlier study showed only a slight difference in participation rate when urine sampling and vaginal swabbing were the choices offered for collection of screening specimens (urine sampling was the preferred solution). 1
Although at the start of our project many general practitioners were doubtful about the possibility of success in their practices, they have discovered that the test is well accepted by most women: 77% of all women who received the specimen collection package from their general practitioner returned a sample. At this point we have analyzed data from 450 patients. In our study, 87% of all respondents preferred obtaining their own sample to having the doctor collect it. We asked the participants to comment on their choices, and their motives might help remove any further barriers to self-screening.
The 13% of women with objections to self-screening gave two main arguments:
1. “The sample should be taken at the occasion of my annual gynecologic examination.” This indeed can be an alternative for a small number of women who have an examination every year, regardless of whether this traditional practice is evidence-based. Although some women believe that this screening is offered by their general practitioners, this usually is not the case.
2. “I'm not sure if a patient-taken sample is reliable.” This objection is frequently raised, and it has been shown to also be a concern for many of the 87% of women who agree to self-screening. This fear, although understandable, is refuted by several studies in which self-taken samples performed almost as well as clinician-obtained ones. 2,3 We supplied our general practitioners with anatomical plates and our patients with illustrated instructions for use, but to put patients at ease they should be reassured that really nothing can go wrong. Such reassurance should be an essential component of future screening programs.
When women are confident about taking their own samples, it can help them feel—as one of the participants wrote—more responsible for the preservation of their sexual health.
PAUL VAN ROYEN
1. Stephenson J, Carder C. Home screening for chlamydial genital infection: is it acceptable to young men and women? Sex Transm Infect 2000; 76: 322–323.
2. Carder C, Robinson AJ. Evaluation of self-taken samples for the presence of genital Chlamydia trachomatis
infection in women using the LCR assay. Int J STD AIDS 1999; 10: 776–777.
3. Wiesenfeld HC, Heine RP. The vaginal introitus: a novel site for Chlamydia trachomatis
testing in women. Am J Obstet Gynecol 1996; 174: 1542–1546.