11 responses to “Indications and value of self-administered vaginal swabs for STIs and vaginitis”

  1. Just curious, what about urine for CG/chlaymdia? I’ve been doing vag swabs for yeast, BV, trich, and urine for the STIs. Is that a reasonable approach?

  2. Can vaginal self swabs for CT/GC be done in pregnancy?

  3. Fantastic article, thanks!

  4. Great article and posters – I was very lucky to work briefly with Dr. Leon as a resident a couple years ago and he is fantastic!

  5. Can you please clarify the comment regarding new STI infection in a woman with a Copper IUD in situ and increasing the risk of PID. I thought that as long as the infection was not acquired in the first 3 weeks after insertion, that there was no increased risk of PID with an IUD in place. Thanks.

  6. Thanks for your comments.
    Theresa: the urine test is women is less accurate that the vaginal swab. Chlamydia is not always present in the urethra, so the pick up rate is about 88-89%, versus 98-99%. I suggest that if they are doing self swabbing for vaginitis, they do it for CT/NG as well with the appropriate swab. If you need the references, please contact me.
    Jennifer: I don’t know of any research on the accuracy of the self swabs in pregnancy, but it wouldn’t be a contraindication. Not sure.
    Sheila: Up To Date states that ‘a trial of over 2500 IUD users, LNg 52/5 IUD users had a significantly lower rates of PID than copper IUD users over a three-year period, which suggests the LNg IUDs may have a protective effect against PID. The article they referred to is: Toivonen J, Luukkainen T, Allonen H. Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years’ comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet Gynecol 1991; 77:261.

  7. Roberto, this is a wonderful TCMP.

    Sheila is correct, that there is no increased risk of STI/PID with copper IUD after the first 3 weeks following insertion. LNg IUS confers some increased protection against STI/PID due to the LNg effect of thickening the cervical mucous. I.e. there is reduced risk of infection with LNg IUS when compared to Cu IUD, but that should not be conflated to mean that Cu IUD confers any increased risk of sexually transmitted infection, including PID! Unprotected sex increases risk of STI, not the copper IUDs. This has now been well demonstrated.
    Marisa Collins, MD MHSc, CCFP, FCFP
    Medical Director, Options for Sexual Health

  8. I wonder if the lubricant gel we use to insert a speculum affects the viability or organisms, making the self swab superior….

  9. I’m a family doc and I have been offering self-swabs for BV/Yeast (our lab has us collect smears, as I live in a remote area and it can be days before the specimen gets to the lab) for a while now. I was prompted to do this by the number of patients I had with on and off, recurrent symptoms, many of whom were asymptomatic when they presented – and who often had negative results. Now I give them a kit with a slide, a swab and a req and they self collect, drop it off at the lab, and call me in a couple of days for the results. It’s helpful to know what we’re dealing with when symptoms are recurrent. It’s nice to know there is evidence for this practice!

    It would be nice to have evidence for pregnancy. Our mat group has been doing urine CG/Chl for low-risk women, but I think I’ll start doing “selfies” instead, despite the lack of evidence.

  10. In our midwifery practice we also tend to do a urine CT-NG at the initial visit. I think switching to “selfies” is brilliant. We are already doing self-collected vaginorectal swabs at 35-37/40 to screen for GBS (great summary of the evidence: https://www.aafp.org/afp/2014/1115/p729.html) with excellent acceptance from our clients.

  11. Having found multiple vaginal retained foreign bodies, like tampons and sponges, in my career, I am very leery about patient self administered vaginal swabs in those who present with symptoms. Screening may be another matter, but I rarely have situations where I would find asymptomatic patients asking for a screen.

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