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Prospective Evaluation of Cervicovaginal Self- and Cervical Physician Collection for the Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium Infections

Lockhart, Alexandre, MS, MPH*; Psioda, Matt, PhD; Ting, Jie, PhD; Campbell, Sara, MD§; Mugo, Nelly, MBChB, MPH; Kwatampora, Jessie, MBChB; Chitwa, Michael, BSc; Kimani, Joshua, MBChB, MPH; Gakure, Anne; Smith, Jennifer, S., PhD, MPH*∥

Sexually Transmitted Diseases: July 2018 - Volume 45 - Issue 7 - p 488–493
doi: 10.1097/OLQ.0000000000000778
Original Studies

Background This study aimed to examine the agreement between sexually transmitted infection (STI) screening using self-collected specimens and physician-collected specimens, and to investigate the acceptability of self-collection for screening in an 18-month study of female sex workers in a high-risk, low-resource setting.

Methods A total of 350 female sex workers in Nairobi, Kenya, participated in a prospective study from 2009 to 2011. Women self-collected a cervicovaginal specimen. Next, a physician conducted a pelvic examination to obtain a cervical specimen. Physician- and self-collected specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium (MG) using Aptima nucleic acid amplification assays (Hologic). Specimens were collected at 3-month intervals over 18-month follow-up. κ Statistics measured agreement of positivity between self-collection and physician collection.

Results Baseline STI prevalence was 2.9% for N. gonorrhoeae, 5.2% for C. trachomatis, 9.2% for T. vaginalis, and 20.1% for MG in self-collected samples, and 2.3%, 3.7%, 7.2%, and 12.9%, respectively, in physician-collected samples. κ Agreement was consistently strong (range, 0.66–1.00) for all STIs over the 18-month study period, except for MG, which had moderate agreement (range, 0.50–0.75). Most participants found self-collection easy (94%) and comfortable (89%) at baseline, with responses becoming modestly more favorable over time.

Conclusions Self-collected specimen screening results showed strong agreement to clinical-collected specimens, except for MG, which was consistently detected more commonly in self-collected than in physician-collected specimens. Acceptability of the self-collection procedure was high at baseline and increased modestly over time. In high-risk, low-resource settings, STI screening with self-collected specimens provides a reliable and acceptable alternative to screening with physician-collected specimens.

A longitudinal study of female sex workers in Nairobi, Kenya, found that self-collection of specimens was comparable to physician collection for the screening of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium infections.

From the Department of *Epidemiology and

Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC;

Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA;

§Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA;

Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya; and

Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Conflict of Interest and Sources of Funding: None declared.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Jennifer S. Smith, PhD, MPH, Department of Epidemiology, University of North Carolina in Chapel Hill, Campus Box 7435, Chapel Hill, NC 27599. E-mail:

Received for publication September 9, 2017, and accepted December 18, 2017.

© Copyright 2018 American Sexually Transmitted Diseases Association