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Prevalence of Chlamydia trachomatis Infections and Specimen Collection Preference Among Women, Using Self-Collected Vaginal Swabs in Community Settings

Richardson, Elizabeth MD, MHSc, FRCP*; Sellors, John W. MD, MSc, CCFP†‡∥; Mackinnon, Sharon RN, BScN, BPHE*; Woodcox, Vicki Med, BScN, RN*; Howard, Michelle MSc; Jang, Dan BSc§∥; Karwalajtys, Tina MA; Chernesky, Max A. PhD§∥

doi: 10.1097/01.OLQ.0000091142.68884.2A

Background Chlamydia trachomatis is a common, often asymptomatic sexually transmitted infection.

Goal The goal was to estimate the prevalence and predictors of C. trachomatis among young women using self-collected vaginal swabs, and the preferences of women and physicians for self-testing.

Study Design A total of 514 attendees of university/college health clinics, adolescent birth control clinics, centers providing health services to homeless youth and adults (street health centers), a sexually transmitted diseases clinic, and family practices were tested by ligase chain reaction. Preference for self- versus provider-testing was examined.

Results Prevalence was 6.0% and was highest (18.2%) in the street health centers. In multivariate analysis, only recent contact with someone with C. trachomatis infection was significantly associated with infection (odds ratio, 7.1; 95% confidence interval, 2.5–20.0). Most women (54.2%; 256 of 472) preferred self-sampling compared with physician sampling (15.9%; 75 of 472). The majority of physicians (75.0%; 9 of 12) reported at the start and end of the study that they would use vaginal swab self-sampling if available.

Conclusions Prevalence of infection in young women attending homeless youth organizations was high. Self-sampling was acceptable and could facilitate screening in high-risk women who do not regularly access health services.

Prevalence of Chlamydia trachomatis (6.0%) in self-collected vaginal swabs ranged from 2.3% in student health centers to 18.2% in centers servicing homeless young women. Self-sampling was preferred over physician sampling.

*Public Health and Community Services Department, City of Hamilton, the Departments of Family Medicine, Clinical Epidemiology and Biostatistics, and §Pathology and Molecular Medicine, McMaster University, Hamilton, and Father Sean O'Sullivan Research Center, St. Joseph's Healthcare, Hamilton, Ontario, Canada

This research was supported by grants provided by the Public Health Research, Education & Development Program (PHRED) and Pfizer Canada.

Dr. Sellors is now affiliated with the Program for Appropriate Technology in Health, Seattle, Washington.

Correspondence: Elizabeth Richardson, MD, MHSc, FRCP, City of Hamilton, Public Health & Community Services Department, 1 Hughson St. N., 4th Floor, Hamilton, Ontario, Canada L8R 3L5. E-mail:

Received for publication March 4, 2003,

revised July 10, 2003, and accepted July 16, 2003.

© Copyright 2003 American Sexually Transmitted Diseases Association