title: The effect of introducing routine self-taken extra-genital swabs in a genitourinary medicine clinic cohort: a before and after study.
abstract: Starting July 2013, all patients attending a sexual health clinic who reported risk of extra-genital infection were offered self-taken extra-genital swabs. The study aim was to assess the detection rate of extra-genital infection since self-taken swabs were introduced. We compared patients diagnosed with chlamydia and gonorrhoea in six-month periods before (February-July 2012) and after (February-July 2014) the introduction of self-taken extra-genital swabs. There were 408 (98 gonorrhoea, 310 chlamydia) detected infections in the 2012 period and 404 (121 gonorrhoea, 283 chlamydia) in 2014. The rate of extra-genital chlamydia/gonorrhoea increased fourfold from 18/408, 4.4% to 77/404 19% (P < 0.0001). The rise was seen in both rectal (8/408, 2% vs. 40/404, 9.9%, P < 0.0001) and pharyngeal infection (10/408, 2.5% vs. 48/404, 11.8% P < 0.0001). Significant rises were seen in men who have sex with men in rectal (5/408, 1.2% vs. 28/404, 6.9% P = 0.001) and pharyngeal infection (10/408, 2.5% vs. 20/404, 5%, P = 0.02) and for women in rectal (3/408, 0.7% vs. 12/404, 3% P = 0.03) and pharyngeal infection (0/408, 0% vs. 20/404, 5%, P < 0.0001). In 100 consecutive patients having extra-genital swabs in each study period, self-swabbing rose from 0% (0/100) to 89% (89/100) P < 0.0001. The introduction of routine self-taken extra-genital swabs has led to a large rise in detected extra-genital chlamydia and/or gonorrhoea infection in men who have sex with men and women.
authors.affiliation: Patrick Clements Clinic, Department of Sexual Health and HIV, London North West Healthcare NHS Trust, Central Middlesex Hospital, Acton Lane, London, UK farai.nyatsanza@nhs.net.
authors.forename: Farai
authors.initials: F
authors.lastname: Nyatsanza
authors.affiliation: Patrick Clements Clinic, Department of Sexual Health and HIV, London North West Healthcare NHS Trust, Central Middlesex Hospital, Acton Lane, London, UK.
authors.forename: Anisha
authors.initials: A
authors.lastname: Trivedy
authors.affiliation: Patrick Clements Clinic, Department of Sexual Health and HIV, London North West Healthcare NHS Trust, Central Middlesex Hospital, Acton Lane, London, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Brook
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000382:microbiology*; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D012007:Rectum / Q000382:microbiology*; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D013048:Specimen Handling; D014521:Urethra / Q000382:microbiology
keywords: Self-taken extra-genital swabs; chlamydia; gonorrhoea; screening; sexual health; sexually transmitted infection