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Feasibility of patient-collected vulval swabs for the diagnosis of Chlamydia trachomatis in a family planning clinic: A pilot study
  1. Susan MacMillan, MRCOG, DFFP, Clinical Research Fellow1,
  2. Hamish McKenzie, BSc, MB ChB, PhD, FRCPath, Senior Lecturer and Honorary Consultant2,
  3. Gillian Flett, FRCOG, MFFP, Consultant in Family Planning and Reproductive Health Family Planning Services3 and
  4. Allan Templeton, MD, FRCOG, Professor4
  1. Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Scotland
  2. Department of Medical Microbiology, University of Aberdeen, Aberdeen, Scotland
  3. Grampian Healthcare NHS Trust, Aberdeen, Scotland
  4. University of Aberdeen, Aberdeen, Scotland
  1. Correspondence Dr Susan Macmillan, Clinical Research Fellow, Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB25 2ZD, Scotland

Abstract

This pilot study set out to determine the feasibility of using patient-collected vulval swabs, instead of urine, for the diagnosis of female Chlamydia trachomatis infection. Main outcome measures included prevalence of infection and sensitivity, specificity, and acceptability of both test methods. An assessment was also made of those who declined to be tested. Consecutive women under 25 years of age attending a single urban family planning clinic were invited to participate. Sixty-eight percent (103/152) agreed to undergo testing. Overall prevalence was 11.7%. The sensitivity/specificity for the ligase chain reaction (LCR) assayed patient-collected vulval swabs and urine was 100%/100% and 92%/100%, respectively. The acceptability of self-collection was high with 93% characterising the test as 'not bad', 79% recommending it to a friend, and 79% choosing the test next time. Significantly more women, however, would choose urine for testing on a subsequent occasion (p < 0.001). Less than 1/5 of the patients who declined did not take part because of concerns regarding the vulval swab. Patient-collected vulval swabs assayed by LCR represent a non-invasive, sensitive, and acceptable way to detect genital C. trachomatis infection in women attending a family planning clinic. Compared with urine testing, benefits in terms of transport and processing should encourage more widespread use of this approach.

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