Can Self-collected Penile Swabs Be Used Instead of Urine Samples for Detection of Chlamydia trachomatis?

Background:
Self-obtained penile swabs collected at home may be easier to obtain and transport than urine samples for detection of chlamydia.

Objective:
To determine the acceptability of self-obtained penile swabs and the accuracy of such samples compared to urine specimens for detection of chlamydia in men, who are recruited via the Internet.

Method:
Participants requested free kits for home collection of specimens using both penile swabs and urines via the Internet or calling a toll-free phone number. Self-obtained samples were collected and questionnaires were completed for demographics, perceptions of use, and sexual risk history. Participants were given the option of not collecting a penile swab and just submitting a urine sample. Samples were tested for chlamydia using the GenProbe APTIMA Combo 2 nucleic acid amplification test.

Result:
Of 491 men requesting kits, 97.6% used the Internet and 2.4% used the phone; 108 (22%) returned samples through the U.S. mail. Most men participating (97.2%) submitted both penile swabs and urines. Chlamydia prevalence was 18.5% (20/108). Fifteen urine samples and 19 penile swabs were positive; one swab sample leaked and was not tested, however the urine was positive. Five of the specimens were swab positive/urine negative. Treatment at collaborating clinics were verified for 19/20 (95%) of chlamydia infected men.

Conclusion:
Self-collected penile swabs were acceptable to men who submitted samples. The swabs identified more chlamydia than urine specimens. Home collection of self-obtained penile swabs and the use of U.S. mail make possible the detection of chlamydia in men who do not access care in STD clinics.

Implications:
Further study could determine methods to incorporate this program into public health outreach practice.