title: Adolescent women can perform a point-of-care test for trichomoniasis as accurately as clinicians.
abstract: OBJECTIVE
  To compare the accuracy (ie, correlation, sensitivity, specificity) of self-performed point-of-care (POC) tests with clinician-performed tests for trichomoniasis in adolescent women.
  
  
  METHODS
  Sexually experienced women aged 14-22&emsp14;years (n=209) collected a vaginal swab and performed a POC test for trichomoniasis. Using a speculum, the clinician obtained vaginal swabs that were tested for trichomoniasis using the POC test, wet mount, culture and transcription-mediated amplification (TMA) using standard and alternative primers. Self and clinician results were compared with true positives, defined as either culture-positive or TMA-positive with both sets of primers.
  
  
  RESULTS
  Participants' mean age was 17.8&emsp14;years; 87% were African-American; 74% reported vaginal itching or discharge and 51 (24%) had trichomoniasis. Over 99% correctly performed and interpreted her self-test. Self and clinician POC tests were highly correlated (95.7% agreement, κ 0.87). Compared with true positives, the sensitivity of the self-POC test was 78% (CI 65% to 89%), similar to that of the clinician-POC test (84%, CI 71% to 93%) and culture (82%, CI 69% to 92%), and significantly better than wet mount (39%, CI 26% to 54%). The specificity of the self-POC test was 99% (CI 96% to 100%), similar to that of the clinician-POC test (100%, CI 98% to 100%). The sensitivity of the self-POC test was not affected by vaginal symptoms or other variables.
  
  
  CONCLUSIONS
  Young women performing a self-POC test detected as many trichomoniasis infections as clinician-POC tests or culture, twice as many as wet mount and slightly fewer than an amplified test. Incorporating self-obtained or self-performed POC tests into routine practice could effectively increase the identification and treatment of trichomoniasis in this vulnerable population.
authors.affiliation: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229-3039, USA. jill.huppert@cchmc.org
authors.forename: Jill S
authors.initials: JS
authors.lastname: Huppert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hesse
authors.forename: Grace
authors.initials: G
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Kim
authors.forename: Patricia
authors.initials: P
authors.lastname: Agreda
authors.forename: Nicole
authors.initials: N
authors.lastname: Quinn
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gaydos
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D019095:Point-of-Care Systems / Q000592:standards*; D012648:Self Care / Q000592:standards*; D012680:Sensitivity and Specificity; D014245:Trichomonas Infections / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods / Q000592:standards; D055815:Young Adult