title: Self-administered vaginal swabs are a feasible alternative to physician-assisted cervical swabs for sexually transmitted infection screening in the emergency department.
abstract: BACKGROUND
  Screening for sexually transmitted infections (STIs) in the emergency department (ED) is limited by the need for pelvic examination. It has been suggested that using self-administered vaginal swabs (SAVS) for this purpose may save time and resources and may be more comfortable for patients.
  
  
  OBJECTIVE
  The objective was to test the feasibility of using SAVS for STI screening in the ED.
  
  
  METHODS
  This was a prospective study of female ED patients 18 to 55 years old who consented to physician-assisted cervical swab (PACS) and SAVS in two urban teaching hospitals. The ED personnel offered the test to all patients, whether or not a pelvic examination was indicated, based on their chief complaint. All specimens were analyzed by polymerase chain reaction (PCR) assay. Data are presented as mean +/- standard deviation (SD). Categorical data are presented as percentages with 95% confidence intervals (CIs). Patients with a positive test result for Chlamydia trachomatis and/or Neisseria gonorrhoeae were considered positive for STI. PACS were used as the criterion standard.
  
  
  RESULTS
  One-hundred sixty-two subjects were enrolled from July 2006 to July 2007 (mean [+/-SD] age = 32 [+/-10] years). Eighty-one percent of patients had a genitourinary symptom (most common: vaginal bleeding/spotting). SAVS had a sensitivity of 91% (95% CI = 60% to 99%), specificity of 99% (95% CI = 95% to 99%), positive likelihood ratio of 91, and negative likelihood ratio of 0.09 in diagnosing STIs. None of the patients reported difficulty or discomfort using this technique.
  
  
  CONCLUSIONS
  Self-administered vaginal swabs can be utilized as a feasible alternative to PACS for STI screening in the ED.
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, NY, USA. nicole.berwald@gmail.com
authors.forename: Nicole
authors.initials: N
authors.lastname: Berwald
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Augenbraun
authors.forename: Khaled
authors.initials: K
authors.lastname: Abu-Lawi
authors.forename: Michael
authors.initials: M
authors.lastname: Lucchesi
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
mesh_terms: D000293:Adolescent; D000328:Adult; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D009519:New York City / Q000453:epidemiology; D010820:Physicians; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D014623:Vaginal Diseases / Q000175:diagnosis* / Q000382:microbiology; D014626:Vaginal Smears / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult