Sexton Mary Elizabeth, Baker Joseph J, Nakagawa Keisuke, Li Ying, Perkins Rodney, Slack Rebecca S, Baker Daniel C, Jucha Brian, Arora Sameer, Plankey Michael W
Emory University School of Medicine, Atlanta, GA, USA.
J Fam Pract. 2013 Feb;62(2):70-8.
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.
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.
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.
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.
近期研究表明，男男性行为者（MSM）中咽部（P）和直肠（R）淋病奈瑟菌（GC）及沙眼衣原体（CT）感染的患病率很高。疾病控制与预防中心的指南建议至少每年进行检测。但对医疗服务提供者的调查显示，由于时间和人员有限，对这些指南的遵守情况微乎其微。出于这些担忧，我们评估了患者自我检测的可行性和准确性。
华盛顿特区一家诊所的374名自认为是MSM且要求进行性传播感染（STI）检测的患者参与了该研究。患者在查看书面和图片说明后，使用Gen-Probe APTIMA Combo 2（AC2）试剂盒进行自我筛查。经过培训的医疗服务提供者也对患者进行了筛查。我们对患者或医疗服务提供者进行检测的顺序进行了随机安排。
在接受特定检测的患者中，8%的患者直肠GC检测呈阳性，9.3%的患者咽部GC检测呈阳性，12.7%的患者直肠CT检测呈阳性，1.3%的患者咽部CT检测呈阳性。我们进行了McNemar检验，按感染类型和解剖部位分层以评估一致性。自我检测在识别咽部GC（不一致率：3%）和直肠GC（不一致率：2.9%）方面明显更好（P≤0.01），并且在检测咽部CT（不一致率：0.5%）和直肠CT（不一致率：1.1%）方面与医疗服务提供者检测的结果相似。
患者中直肠和口腔淋病及衣原体的检测率相当或更高，这表明患者能够自行进行性传播感染筛查，这可能会增加感染的检测和治疗。
