title: How reliable is self-testing for gonorrhea and chlamydia among men who have sex with men?
abstract: BACKGROUND
  Recent studies have demonstrated a high prevalence of pharyngeal (P) and rectal (R) Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections among men who have sex with men (MSM). Guidelines by the Centers for Disease Control and Prevention recommend testing at least annually. But surveys of medical providers suggest that adherence to these guidelines is minimal as a result of limited time and staff. Because of these concerns, we evaluated the feasibility and accuracy of patient self-testing.
  
  
  METHODS
  Three-hundred seventy-four patients at a Washington, DC clinic who identified themselves as MSM and requested testing for sexually transmitted infections (STIs) participated in the study. Patients performed self-screening using the Gen-Probe APTIMA Combo 2 (AC2) kit after viewing written and pictorial instructions. Trained providers also screened patients. We randomized the order in which patients or providers performed testing.
  
  
  RESULTS
  Among those receiving specific tests, 8% of patients tested positive for R-GC, 9.3% for P-GC, 12.7% for R-CT, and 1.3% for P-CT. We performed McNemar tests, stratified by infection type and anatomic site to evaluate concordance. Self-administered testing was significantly better at identifying P-GC (discordant: 3%) and R-GC (discordant: 2.9%) (P ≤.01), and had results similar to provider- administered testing for P-CT (discordant: 0.5%) and R-CT (discordant: 1.1%) detection.
  
  
  CONCLUSIONS
  The equivalent or better detection rates for rectal and oral gonorrhea and chlamydia among patients suggest that patients are capable of performing their own screening for STIs, which may increase infection detection and treatment.
authors: Emory University School of Medicine, Atlanta, GA, USA.
authors: Mary Elizabeth
authors: ME
authors: Sexton
authors: Joseph J
authors: JJ
authors: Baker
authors: Keisuke
authors: K
authors: Nakagawa
authors: Ying
authors: Y
authors: Li
authors: Rodney
authors: R
authors: Perkins
authors: Rebecca S
authors: RS
authors: Slack
authors: Daniel C
authors: DC
authors: Baker
authors: Brian
authors: B
authors: Jucha
authors: Sameer
authors: S
authors: Arora
authors: Michael W
authors: MW
authors: Plankey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae; D010608:Pharyngeal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012002:Rectal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D015203:Reproducibility of Results; D016353:Self-Examination / Q000379:methods*; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult