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PRACTICE CHANGER
Ask women who are at risk for sexually transmitted infections (STIs) to self-swab for chlamydia and gonorrhea testing; self-collection of vulvovaginal swabs with nucleic acid amplification testing (NAAT) has excellent sensitivity in women with and without symptoms.1,2
STRENGTH OF RECOMMENDATION
B: Based on a prospective diagnostic cohort study.1,2
ILLUSTRATIVE CASE
An 18-year-old patient requests testing for STIs. She has no symptoms. What is the best way to collect samples for chlamydia and gonorrhea testing?
Despite public health efforts, chlamydia and gonorrhea remain significant health problems, with more than 1.4 million cases of chlamydia and 321,849 cases of gonorrhea reported in the United States in 2011.3 Both can have devastating effects on reproduction, even in women who are asymptomatic.
Annual testing recommended for at-risk women
According to the CDC, most reported cases of chlamydia (70%) and gonorrhea (62%) occur in men and women between the ages of 15 and 24.3 Both the CDC and the US Preventive Services Task Force recommend annual chlamydia screening for all sexually active women younger than 25 and for older women who have certain risk factors (eg, having multiple sex partners or living in communities with a high burden of disease).4,5 Annual gonorrhea screening is also recommended for sexually active women with risk factors.4,5
How best to test? A number of unknowns
NAAT is the most sensitive test for detection of chlamydia and gonorrhea, but other questions about how best to screen for STIs remain.1,6 It has not been clear whether self-collected vulvovaginal swabs are equivalent to clinician-collected urethral or endocervical swabs for the detection of gonorrhea, or whether NAAT testing of the self-collected swabs or culture of the clinician-collected swabs is a more sensitive test for gonorrhea.
While some studies have found self-collected vulvovaginal samples to be as sensitive as clinician-collected endocervical samples for the diagnosis of chlamydia and gonorrhea, samples are still often collected by clinicians.7,8 Collecting endocervical swabs is uncomfortable for patients and time consuming for clinicians, and evidence suggests that patients prefer noninvasive sampling.9
STUDY SUMMARY
Self-collected samples are highly sensitive
This study was designed to compare the sensitivity and specificity of self-collected vulvovaginal swabs with that of clinician-collected swabs for chlamydia and gonorrhea, both in asymptomatic women and women with symptoms of an STI. Test methods were also assessed for gonorrhea, comparing detection rates of self-swabs tested with NAAT and the culture of clinician-collected urethral and endocervical samples.
The researchers evaluated a total of 3,973 women, ages 16 to 59, who sought care at a single sexual health center in the United Kingdom. The average age was 25; 37% of the participants reported a prior STI, and 42% had at least one symptom suggestive of an STI. Women were excluded from the study if they had taken an antibiotic in the preceding 28 days or were unable/unwilling to take a vulvovaginal swab or undergo clinician examination and sample collection.
The women performed vulvovaginal swabs for NAAT prior to a speculum exam; endocervical swab for both NAAT and culture and a urethral swab for culture were collected by the clinician. All the swabs sent for NAAT were tested for chlamydia and gonorrhea, and cultures were performed to detect gonorrhea.
Chlamydia: Vulvovaginal swabs have higher detection rates
Of the 3,867 participants with complete results, 10.2% were infected with chlamydia. Self-collected vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% vs 88%) and had equal specificity (99.9% vs 100%). In women with symptoms of an STI, the sensitivity was 97% vs 88%; in those with no symptoms, the sensitivity was 97% vs 89%.
Gonorrhea: Self-collection, NAAT yield better results
Gonorrhea was found in 2.5% of the 3,859 women with complete results for testing of this STI. Self-collected swabs and clinician-collected swabs analyzed by NAAT both had excellent sensitivity (99% and 96%, respectively). But self-collected samples that underwent NAAT were significantly more sensitive than clinician-collected urethral and endocervical samples that were cultured (99% vs 81%). The number needed to test by self-collection for NAAT (compared with clinician-collected culture) to detect one additional case of gonorrhea was 5.
In women with symptoms suggestive of infection, the NAAT assays—both clinician- and self-collected—were equivalent and were more sensitive than gonorrhea culture. In asymptomatic women, 1.8% of whom had gonorrhea, the vulvovaginal swab sent for NAAT was more sensitive than culture (98% vs 78%) and was equivalent to the endocervical swab for NAAT (90%).
The bottom line: Self-collected vulvovaginal swabs are the sample of choice for both chlamydia and gonorrhea testing in women, regardless of whether they have symptoms. When a clinical examination is needed, either the clinician or the patient can collect a vulvovaginal swab.
WHAT’S NEW
Endocervical samples, cultures have lower detection rates
In this study, endocervical samples collected by the clinician rather than self-collected vulvovaginal samples would have missed 9% (one in 11) of chlamydial infections in women with symptoms of an STI. Vulvovaginal swabs and endocervical swabs have equal sensitivity for the diagnosis of gonorrhea when NAAT is used, but culture would have missed one in five gonorrhea infections (in women with and without symptoms).
CAVEATS
NAAT is costly and does not test for drug sensitivity
Although NAAT has replaced cell culture methodology as the gold standard for gonorrhea and chlamydia diagnosis, it is potentially costly if not readily available in your practice setting. What’s more, NAAT does not allow testing for antibiotic sensitivity, which is particularly relevant with increasing resistance of gonorrhea to multiple antibiotics. In addition, it’s unclear whether these results would apply to all NAAT assays or just the one used in this study.
These studies examine sensitivity and specificity of gonorrhea and chlamydia testing in a high-risk population: women who were seeking care in a sexual health center. Your patient population may be at lower risk, which will lower the prevalence of STIs and lower the positive predictive value of NAAT. A positive NAAT test for an STI should be followed by a confirmation NAAT in low-risk populations.
CHALLENGES TO IMPLEMENTATION
Reconsidering the way we practice
Most family practice providers are accustomed to performing a full examination on patients with a suspected STI, and changing the flow of the office visit may be difficult. And to implement this practice changer properly, it would be necessary to provide patient instruction in self-collection technique.
Also, making this change could be costly if you do not have this particular NAAT available. Once implemented, however, self-collection with NAAT will likely save time and be more comfortable for your patients. It will also provide a higher sensitivity in detecting chlamydia infections and equal sensitivity in detecting gonorrhea, compared with clinician-collected NAAT testing.
REFERENCES
1. Schoeman SA, Stewart CM, Booth RA, et al. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
2. Stewart CM, Schoeman SA, Booth RA, et al. Assessment of self taken swabs versus clinician taken swab for cultures for diagnosing gonorrhea in women: single centre, diagnostic accuracy study. BMJ. 2012;345: e8107.
3. CDC. Fact sheet: STD trends in the United States—2011 national data for chlamydia, gonorrhea, and syphilis (2012). www.cdc.gov/std/stats11/trends-2011.pdf. Accessed November 15, 2013.
4. CDC. Fact sheet: Incidence, prevalence, and cost of sexually transmitted infections in the United States (2013). www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf. Accessed November 15, 2013.
5. United States Preventive Services Task Force. USPSTF Recommendations for STI screening (2008). www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm. Accessed November 15, 2013.
6. CDC. 2010 STD treatment guidelines. www.cdc.gov/std/treatment/2010/default.htm. Accessed November 15, 2013.
7. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: non-invasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914-925.
8. Moss S, Mallinson H. The contribution of APTIMA Combo 2 assay to the diagnosis of gonorrhoea in genitourinary medicine setting. Int J STD AIDS. 2007;18:551-554.
9. Chernesky MA, Hook EW 3rd, Martin DH, et al. Women find it easy and prefer to collect their own vaginal swabs to diagnose Chlamydia trachomatis or Neisseria gonorrhaea infections. Sex Transm Dis. 2005;32: 729-733.
ACKNOWLEDGEMENT
The PURLs Surveillance System is supported in part by Grant Number UL 1RR 024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Copyright © 2013. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2013;62(11):651-653.
PRACTICE CHANGER
Ask women who are at risk for sexually transmitted infections (STIs) to self-swab for chlamydia and gonorrhea testing; self-collection of vulvovaginal swabs with nucleic acid amplification testing (NAAT) has excellent sensitivity in women with and without symptoms.1,2
STRENGTH OF RECOMMENDATION
B: Based on a prospective diagnostic cohort study.1,2
ILLUSTRATIVE CASE
An 18-year-old patient requests testing for STIs. She has no symptoms. What is the best way to collect samples for chlamydia and gonorrhea testing?
Despite public health efforts, chlamydia and gonorrhea remain significant health problems, with more than 1.4 million cases of chlamydia and 321,849 cases of gonorrhea reported in the United States in 2011.3 Both can have devastating effects on reproduction, even in women who are asymptomatic.
Annual testing recommended for at-risk women
According to the CDC, most reported cases of chlamydia (70%) and gonorrhea (62%) occur in men and women between the ages of 15 and 24.3 Both the CDC and the US Preventive Services Task Force recommend annual chlamydia screening for all sexually active women younger than 25 and for older women who have certain risk factors (eg, having multiple sex partners or living in communities with a high burden of disease).4,5 Annual gonorrhea screening is also recommended for sexually active women with risk factors.4,5
How best to test? A number of unknowns
NAAT is the most sensitive test for detection of chlamydia and gonorrhea, but other questions about how best to screen for STIs remain.1,6 It has not been clear whether self-collected vulvovaginal swabs are equivalent to clinician-collected urethral or endocervical swabs for the detection of gonorrhea, or whether NAAT testing of the self-collected swabs or culture of the clinician-collected swabs is a more sensitive test for gonorrhea.
While some studies have found self-collected vulvovaginal samples to be as sensitive as clinician-collected endocervical samples for the diagnosis of chlamydia and gonorrhea, samples are still often collected by clinicians.7,8 Collecting endocervical swabs is uncomfortable for patients and time consuming for clinicians, and evidence suggests that patients prefer noninvasive sampling.9
STUDY SUMMARY
Self-collected samples are highly sensitive
This study was designed to compare the sensitivity and specificity of self-collected vulvovaginal swabs with that of clinician-collected swabs for chlamydia and gonorrhea, both in asymptomatic women and women with symptoms of an STI. Test methods were also assessed for gonorrhea, comparing detection rates of self-swabs tested with NAAT and the culture of clinician-collected urethral and endocervical samples.
The researchers evaluated a total of 3,973 women, ages 16 to 59, who sought care at a single sexual health center in the United Kingdom. The average age was 25; 37% of the participants reported a prior STI, and 42% had at least one symptom suggestive of an STI. Women were excluded from the study if they had taken an antibiotic in the preceding 28 days or were unable/unwilling to take a vulvovaginal swab or undergo clinician examination and sample collection.
The women performed vulvovaginal swabs for NAAT prior to a speculum exam; endocervical swab for both NAAT and culture and a urethral swab for culture were collected by the clinician. All the swabs sent for NAAT were tested for chlamydia and gonorrhea, and cultures were performed to detect gonorrhea.
Chlamydia: Vulvovaginal swabs have higher detection rates
Of the 3,867 participants with complete results, 10.2% were infected with chlamydia. Self-collected vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% vs 88%) and had equal specificity (99.9% vs 100%). In women with symptoms of an STI, the sensitivity was 97% vs 88%; in those with no symptoms, the sensitivity was 97% vs 89%.
Gonorrhea: Self-collection, NAAT yield better results
Gonorrhea was found in 2.5% of the 3,859 women with complete results for testing of this STI. Self-collected swabs and clinician-collected swabs analyzed by NAAT both had excellent sensitivity (99% and 96%, respectively). But self-collected samples that underwent NAAT were significantly more sensitive than clinician-collected urethral and endocervical samples that were cultured (99% vs 81%). The number needed to test by self-collection for NAAT (compared with clinician-collected culture) to detect one additional case of gonorrhea was 5.
In women with symptoms suggestive of infection, the NAAT assays—both clinician- and self-collected—were equivalent and were more sensitive than gonorrhea culture. In asymptomatic women, 1.8% of whom had gonorrhea, the vulvovaginal swab sent for NAAT was more sensitive than culture (98% vs 78%) and was equivalent to the endocervical swab for NAAT (90%).
The bottom line: Self-collected vulvovaginal swabs are the sample of choice for both chlamydia and gonorrhea testing in women, regardless of whether they have symptoms. When a clinical examination is needed, either the clinician or the patient can collect a vulvovaginal swab.
WHAT’S NEW
Endocervical samples, cultures have lower detection rates
In this study, endocervical samples collected by the clinician rather than self-collected vulvovaginal samples would have missed 9% (one in 11) of chlamydial infections in women with symptoms of an STI. Vulvovaginal swabs and endocervical swabs have equal sensitivity for the diagnosis of gonorrhea when NAAT is used, but culture would have missed one in five gonorrhea infections (in women with and without symptoms).
CAVEATS
NAAT is costly and does not test for drug sensitivity
Although NAAT has replaced cell culture methodology as the gold standard for gonorrhea and chlamydia diagnosis, it is potentially costly if not readily available in your practice setting. What’s more, NAAT does not allow testing for antibiotic sensitivity, which is particularly relevant with increasing resistance of gonorrhea to multiple antibiotics. In addition, it’s unclear whether these results would apply to all NAAT assays or just the one used in this study.
These studies examine sensitivity and specificity of gonorrhea and chlamydia testing in a high-risk population: women who were seeking care in a sexual health center. Your patient population may be at lower risk, which will lower the prevalence of STIs and lower the positive predictive value of NAAT. A positive NAAT test for an STI should be followed by a confirmation NAAT in low-risk populations.
CHALLENGES TO IMPLEMENTATION
Reconsidering the way we practice
Most family practice providers are accustomed to performing a full examination on patients with a suspected STI, and changing the flow of the office visit may be difficult. And to implement this practice changer properly, it would be necessary to provide patient instruction in self-collection technique.
Also, making this change could be costly if you do not have this particular NAAT available. Once implemented, however, self-collection with NAAT will likely save time and be more comfortable for your patients. It will also provide a higher sensitivity in detecting chlamydia infections and equal sensitivity in detecting gonorrhea, compared with clinician-collected NAAT testing.
REFERENCES
1. Schoeman SA, Stewart CM, Booth RA, et al. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
2. Stewart CM, Schoeman SA, Booth RA, et al. Assessment of self taken swabs versus clinician taken swab for cultures for diagnosing gonorrhea in women: single centre, diagnostic accuracy study. BMJ. 2012;345: e8107.
3. CDC. Fact sheet: STD trends in the United States—2011 national data for chlamydia, gonorrhea, and syphilis (2012). www.cdc.gov/std/stats11/trends-2011.pdf. Accessed November 15, 2013.
4. CDC. Fact sheet: Incidence, prevalence, and cost of sexually transmitted infections in the United States (2013). www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf. Accessed November 15, 2013.
5. United States Preventive Services Task Force. USPSTF Recommendations for STI screening (2008). www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm. Accessed November 15, 2013.
6. CDC. 2010 STD treatment guidelines. www.cdc.gov/std/treatment/2010/default.htm. Accessed November 15, 2013.
7. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: non-invasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914-925.
8. Moss S, Mallinson H. The contribution of APTIMA Combo 2 assay to the diagnosis of gonorrhoea in genitourinary medicine setting. Int J STD AIDS. 2007;18:551-554.
9. Chernesky MA, Hook EW 3rd, Martin DH, et al. Women find it easy and prefer to collect their own vaginal swabs to diagnose Chlamydia trachomatis or Neisseria gonorrhaea infections. Sex Transm Dis. 2005;32: 729-733.
ACKNOWLEDGEMENT
The PURLs Surveillance System is supported in part by Grant Number UL 1RR 024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Copyright © 2013. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2013;62(11):651-653.
PRACTICE CHANGER
Ask women who are at risk for sexually transmitted infections (STIs) to self-swab for chlamydia and gonorrhea testing; self-collection of vulvovaginal swabs with nucleic acid amplification testing (NAAT) has excellent sensitivity in women with and without symptoms.1,2
STRENGTH OF RECOMMENDATION
B: Based on a prospective diagnostic cohort study.1,2
ILLUSTRATIVE CASE
An 18-year-old patient requests testing for STIs. She has no symptoms. What is the best way to collect samples for chlamydia and gonorrhea testing?
Despite public health efforts, chlamydia and gonorrhea remain significant health problems, with more than 1.4 million cases of chlamydia and 321,849 cases of gonorrhea reported in the United States in 2011.3 Both can have devastating effects on reproduction, even in women who are asymptomatic.
Annual testing recommended for at-risk women
According to the CDC, most reported cases of chlamydia (70%) and gonorrhea (62%) occur in men and women between the ages of 15 and 24.3 Both the CDC and the US Preventive Services Task Force recommend annual chlamydia screening for all sexually active women younger than 25 and for older women who have certain risk factors (eg, having multiple sex partners or living in communities with a high burden of disease).4,5 Annual gonorrhea screening is also recommended for sexually active women with risk factors.4,5
How best to test? A number of unknowns
NAAT is the most sensitive test for detection of chlamydia and gonorrhea, but other questions about how best to screen for STIs remain.1,6 It has not been clear whether self-collected vulvovaginal swabs are equivalent to clinician-collected urethral or endocervical swabs for the detection of gonorrhea, or whether NAAT testing of the self-collected swabs or culture of the clinician-collected swabs is a more sensitive test for gonorrhea.
While some studies have found self-collected vulvovaginal samples to be as sensitive as clinician-collected endocervical samples for the diagnosis of chlamydia and gonorrhea, samples are still often collected by clinicians.7,8 Collecting endocervical swabs is uncomfortable for patients and time consuming for clinicians, and evidence suggests that patients prefer noninvasive sampling.9
STUDY SUMMARY
Self-collected samples are highly sensitive
This study was designed to compare the sensitivity and specificity of self-collected vulvovaginal swabs with that of clinician-collected swabs for chlamydia and gonorrhea, both in asymptomatic women and women with symptoms of an STI. Test methods were also assessed for gonorrhea, comparing detection rates of self-swabs tested with NAAT and the culture of clinician-collected urethral and endocervical samples.
The researchers evaluated a total of 3,973 women, ages 16 to 59, who sought care at a single sexual health center in the United Kingdom. The average age was 25; 37% of the participants reported a prior STI, and 42% had at least one symptom suggestive of an STI. Women were excluded from the study if they had taken an antibiotic in the preceding 28 days or were unable/unwilling to take a vulvovaginal swab or undergo clinician examination and sample collection.
The women performed vulvovaginal swabs for NAAT prior to a speculum exam; endocervical swab for both NAAT and culture and a urethral swab for culture were collected by the clinician. All the swabs sent for NAAT were tested for chlamydia and gonorrhea, and cultures were performed to detect gonorrhea.
Chlamydia: Vulvovaginal swabs have higher detection rates
Of the 3,867 participants with complete results, 10.2% were infected with chlamydia. Self-collected vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% vs 88%) and had equal specificity (99.9% vs 100%). In women with symptoms of an STI, the sensitivity was 97% vs 88%; in those with no symptoms, the sensitivity was 97% vs 89%.
Gonorrhea: Self-collection, NAAT yield better results
Gonorrhea was found in 2.5% of the 3,859 women with complete results for testing of this STI. Self-collected swabs and clinician-collected swabs analyzed by NAAT both had excellent sensitivity (99% and 96%, respectively). But self-collected samples that underwent NAAT were significantly more sensitive than clinician-collected urethral and endocervical samples that were cultured (99% vs 81%). The number needed to test by self-collection for NAAT (compared with clinician-collected culture) to detect one additional case of gonorrhea was 5.
In women with symptoms suggestive of infection, the NAAT assays—both clinician- and self-collected—were equivalent and were more sensitive than gonorrhea culture. In asymptomatic women, 1.8% of whom had gonorrhea, the vulvovaginal swab sent for NAAT was more sensitive than culture (98% vs 78%) and was equivalent to the endocervical swab for NAAT (90%).
The bottom line: Self-collected vulvovaginal swabs are the sample of choice for both chlamydia and gonorrhea testing in women, regardless of whether they have symptoms. When a clinical examination is needed, either the clinician or the patient can collect a vulvovaginal swab.
WHAT’S NEW
Endocervical samples, cultures have lower detection rates
In this study, endocervical samples collected by the clinician rather than self-collected vulvovaginal samples would have missed 9% (one in 11) of chlamydial infections in women with symptoms of an STI. Vulvovaginal swabs and endocervical swabs have equal sensitivity for the diagnosis of gonorrhea when NAAT is used, but culture would have missed one in five gonorrhea infections (in women with and without symptoms).
CAVEATS
NAAT is costly and does not test for drug sensitivity
Although NAAT has replaced cell culture methodology as the gold standard for gonorrhea and chlamydia diagnosis, it is potentially costly if not readily available in your practice setting. What’s more, NAAT does not allow testing for antibiotic sensitivity, which is particularly relevant with increasing resistance of gonorrhea to multiple antibiotics. In addition, it’s unclear whether these results would apply to all NAAT assays or just the one used in this study.
These studies examine sensitivity and specificity of gonorrhea and chlamydia testing in a high-risk population: women who were seeking care in a sexual health center. Your patient population may be at lower risk, which will lower the prevalence of STIs and lower the positive predictive value of NAAT. A positive NAAT test for an STI should be followed by a confirmation NAAT in low-risk populations.
CHALLENGES TO IMPLEMENTATION
Reconsidering the way we practice
Most family practice providers are accustomed to performing a full examination on patients with a suspected STI, and changing the flow of the office visit may be difficult. And to implement this practice changer properly, it would be necessary to provide patient instruction in self-collection technique.
Also, making this change could be costly if you do not have this particular NAAT available. Once implemented, however, self-collection with NAAT will likely save time and be more comfortable for your patients. It will also provide a higher sensitivity in detecting chlamydia infections and equal sensitivity in detecting gonorrhea, compared with clinician-collected NAAT testing.
REFERENCES
1. Schoeman SA, Stewart CM, Booth RA, et al. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
2. Stewart CM, Schoeman SA, Booth RA, et al. Assessment of self taken swabs versus clinician taken swab for cultures for diagnosing gonorrhea in women: single centre, diagnostic accuracy study. BMJ. 2012;345: e8107.
3. CDC. Fact sheet: STD trends in the United States—2011 national data for chlamydia, gonorrhea, and syphilis (2012). www.cdc.gov/std/stats11/trends-2011.pdf. Accessed November 15, 2013.
4. CDC. Fact sheet: Incidence, prevalence, and cost of sexually transmitted infections in the United States (2013). www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf. Accessed November 15, 2013.
5. United States Preventive Services Task Force. USPSTF Recommendations for STI screening (2008). www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm. Accessed November 15, 2013.
6. CDC. 2010 STD treatment guidelines. www.cdc.gov/std/treatment/2010/default.htm. Accessed November 15, 2013.
7. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: non-invasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914-925.
8. Moss S, Mallinson H. The contribution of APTIMA Combo 2 assay to the diagnosis of gonorrhoea in genitourinary medicine setting. Int J STD AIDS. 2007;18:551-554.
9. Chernesky MA, Hook EW 3rd, Martin DH, et al. Women find it easy and prefer to collect their own vaginal swabs to diagnose Chlamydia trachomatis or Neisseria gonorrhaea infections. Sex Transm Dis. 2005;32: 729-733.
ACKNOWLEDGEMENT
The PURLs Surveillance System is supported in part by Grant Number UL 1RR 024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Copyright © 2013. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2013;62(11):651-653.