The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Wednesday, March 12, 2008
P80

Self-collected Versus Provider-collected Rectal Screening for Gonorrhea and Chlamydia in Men Who Have Sex with Men

Christine L. Wigen1, Ellen T. Rudy1, Elisa Clay2, Robert Bolan2, Jason Hall2, Sarah L. Guerry1, and Peter Kerndt1. (1) Sexually Transmitted Disease Program, Los Angeles County Department of Public Health, 2615 S. Grand Ave., Room 500, Los Angeles, CA, USA, (2) Sexual Health Program, Los Angeles Gay and Lesbian Center, 1625 N. Schrader Blvd, Los Angeles, CA, USA


Background:
The Centers for Disease Control and Prevention (CDC) recommend rectal Chlamydia (CT) and gonorrhea (GC) screening for men who report receptive anal sex. Inadequate staffing at STD/HIV screening sites may limit compliance with rectal screening recommendations.

Objective:
To compare results of self-collected versus provider-collected rectal specimens for GCCT nucleic acid amplification testing (NAAT).

Method:
MSM who reported receptive anal sex were offered rectal GC/CT screening at a sexual health clinic. 220 paired provider-collected and self-collected rectal specimens were obtained between August and October 2007. A validated NAAT assay was used to test specimens. The results were recorded and analyzed using SAS v.9.0. We calculated the percent agreement and Kappa statistic to measure the pair-wise concordance of provider-collected and self-collected results. Improper samples were excluded from the final analysis. To assess sensitivity we used the composite reference as the standard.

Result:
Of the 220 paired specimens collected, 2 GC/CT provider samples and 1 self-collected CT specimen were deemed indeterminate by the lab. The overall prevalence of rectal CT was 18% (40/217); rectal GC was 19% (42/218). Percent agreement for detection of rectal CT and GC was 97% and 95%, respectively. Rectal CT was found in 37 of the paired specimens; 39 from the self-collected and 40 from the provider-collected specimens. Rectal GC was found in 34 of the paired specimens; 42 from the self-collected and 37 from the provider-collected specimens. Kappa coefficient and 95% confidence limits (CL) for rectal CT and GC were 0.92 (95% CL: 0.86, 0.99) and 0.83 (95% CL: 0.73, 0.93), respectively. Self-collected rectal CT and GC sensitivity were 0.93. Provider-collected CT and GC sensitivity were 0.95 and 0.82, respectively.

Conclusion:
Self-collected rectal swabs performed as well as provider-collected rectal swabs.

Implications:
The self collection-method is a feasible alternative in understaffed settings to increase screening.

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