title: Mailed urine samples are not an effective screening approach for Chlamydia trachomatis case finding among young men.
abstract: BACKGROUND
  Frequency of testing is known to be low for sexually transmitted infections (STIs) in men aged 20-24 years. The use of mailed, home-obtained urine specimens could increase the uptake of young men and facilitate screening programmes for the detection of asymptomatic Chlamydia trachomatis.
  
  
  OBJECTIVE
  The aim of the present study is to evaluate the home screening approach as a tool for recruitment of asymptomatic men for screening of genital C. trachomatis infections.
  
  
  METHODS
  Men aged 19-24 years old (n = 1936) were invited to participate in home-based testing for genital C. trachomatis infection. Persons who agreed to be tested were provided with a testing kit. Self-collected first void urine was sent for testing to the microbiology laboratory. The test result was accessible on the study's web-page 1 week after testing. Individuals with a diagnosed infection were instructed to contact the venereal disease department.
  
  
  RESULTS
  The response rate was 24% (462/1936). The responders' main reason for not participating was a feeling of being safe regarding STIs (87%; 159/182). The primary reason for this feeling of safety was that the responders were in a steady relationship (59%; 107/159). Having sex outside a steady relationship was reported by 36% (90/250) of the responders. The prevalence of C. trachomatis infection among the responders was 2.02% and the reported history of chlamydial infection was 36% (34/95). Out of the responders, 92% (229/249) were, to varying degrees, concerned about getting STIs; however, the majority (72%; 174/242) estimated the risk to be low.
  
  
  CONCLUSIONS
  Home screening using web-based answer management is a feasible tool for STI screening, which lowers the threshold for people at risk. In this particular population, however, the response rate was too low to be routinely introduced.
authors.affiliation: WHO Collaborating Centre for the Diagnosis and Research of Chlamydial and Other Reproductive Tract Infections, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. marius.domeika@medsci.uu.se
authors.forename: M
authors.initials: M
authors.lastname: Domeika
authors.forename: L
authors.initials: L
authors.lastname: Oscarsson
authors.forename: A
authors.initials: A
authors.lastname: Hallén
authors.forename: E
authors.initials: E
authors.lastname: Hjelm
authors.forename: S
authors.initials: S
authors.lastname: Sylvan
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology / Q000652:urine*; D002692:Chlamydia trachomatis; D006699:Home Care Services; D006801:Humans; D020407:Internet; D008297:Male; D052801:Male Urogenital Diseases / Q000453:epidemiology / Q000652:urine*; D008403:Mass Screening / Q000379:methods*; D011177:Postal Service; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology