USE OF SELF-COLLECTED VAGINAL SPECIMENS FOR DETECTION OF CHLAMYDIA-TRACHOMATIS INFECTION

Objective: To evaluate the efficacy of a self-collected vaginal introi tal specimen, obtained by women using only an instruction booklet as a guide, for the detection of Chlamydia trachomatis using polymerase ch ain reaction (PCR). Methods: Comparison analysis in an Urban hospital clinic, using a convenience sample of 101 women undergoing screening o r treatment for C trachomatis infection. Subjects were given an illust rated instruction booklet and were asked to collect a single specimen from the vaginal introitus using the Amplicor collection kit. Cervical and introital specimens then were obtained by clinicians. The presenc e of C trachomatis in patient-collected versus clinician-collected sam ples was determined by PCR. Discordant specimens were retested by PCR, using primer pairs to the C trachomatis major outer:membrane protein gene, and were screened for the presence of PCR assay inhibitors. Resu lts: Ninety-nine subjects completed the self-collection. Sixty-two per cent were adolescents and 17% spoke English as their second language. Forty-three percent had never used tampons, and 36% had never looked a t their own genitals. Twenty-eight cervical specimens (28%), 32 clinic ian-collected introital specimens (32%), and 33 self-collected introit al specimens (33%) were positive for C trachomatis infection. All clin ician-collected introital specimens that were positive for C trachomat is and all cervical specimens that were positive for C trachomatis wer e positive on self-test. Compared with clinician-collected introital s pecimens, self-collected specimens had a sensitivity of 100% and a spe cificity of 98.5%. Compared with cervical specimens, self-collected sp ecimens had a sensitivity of 100% and a specificity of 93.4%. After di screpant analysis, self-test had a sensitivity of 100% and a specifici ty of 94.6% for detection of C trachomatis cervical infection. Conclus ion: Self-collection of introital samples is both sensitive and specif ic in screening for C trachomatis. (C) 1998 by The American College of Obstetricians and Gynecologists.