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A Randomized Trial of Home Versus Clinic-Based Sexually Transmitted Disease Screening Among Men

Reagan, Mary M. BS; Xu, Hanna BS; Shih, Shirley L. MD; Secura, Gina M. PhD, MPH; Peipert, Jeffrey F. MD, PhD

doi: 10.1097/OLQ.0b013e3182649165
Original Study

Background Preventing sexually transmitted diseases (STD) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) remains a public health challenge. The U.S. Preventive Services Task Force suggests STD screening among men will likely lead to a decrease in infection rates of women. However, innovative approaches are necessary to increase the traditionally low rates of male screening. The purpose of this study is to compare the acceptability and effectiveness of home-based versus clinic-based urine screening for CT and GC in men.

Methods We conducted a randomized clinical trial of 200 men aged 18 to 45 years who reside in St. Louis, MO. Men were enrolled via telephone and randomly assigned to receive a free urine CT/GC screening kit either in-person at the research clinic or to have it mailed to the participant’s preferred address. Participants completed questionnaires at baseline and 10 to 12 weeks postenrollment. The primary outcome was whether STD screening was completed.

Results Sixty percent (120/200) completed STD screening. Men assigned to home-based screening were 60% more likely to complete screening compared with clinic-based screening (72% vs. 48%, RRadj = 1.6, 95% CI = 1.3, 2.00). We identified 4 cases of CT or GC in the home-based group compared with 3 cases of CT in the clinic group. Men who completed screening were significantly more likely to be white, younger, and college educated.

Conclusions Home-based screening for CT and GC among men is more acceptable than clinic-based screening and resulted in higher rates of screening completion. Incorporating home-based methods as adjuncts to traditional STD screening options shows promise in improving STD screening rates in men.

Home-based nucleic acid amplification screening kits of urine specimens for Chlamydia trachomatis and Neisseria gonorrhoeae achieved higher screening rates in men compared to clinic-based screening.

From the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO

Study funded by an Anonymous Foundation and Grant Numbers UL1 RR024992 and TL1 RR024995 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. This work was also supported by a grant from the Doris Duke Charitable Foundation to Washington University in St. Louis School of Medicine to fund Clinical Research Fellow Hanna Xu.

Correspondence: Jeffrey F. Peipert, MD, PhD, Vice Chair of Clinical Research, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4533 Clayton Avenue, Campus Box 8219, St. Louis, MO 63110. E-mail:

Received for publication March 14, 2012, and accepted June 11, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association