Quebec City – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.
Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.
In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.
Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.
The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.
Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.
The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.
The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.
There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.
Test results were no different based on whether the patient or the health care provider collected samples first.
Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.
"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.
The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.
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