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We assessed the concept of self sampling, as part of screening for sexually transmitted diseases, first in the early 1990s in a pilot study.1 The aim was to assess the validity and acceptability of the procedure as an alternative for the sex industry workers (or as a supplementary method between attendances), for those who are reluctant or unable to attend GUM clinics frequently. Microbiological techniques then were not as developed or as sensitive as today’s (PCR) tests.2 Since then, other studies reported on the feasibility and acceptability of self obtained samples.3,4
We read with interest, the article published in STI5 regarding the diagnosis of chlamydia, gonorrhoea and trichomonas infections by self obtained low vaginal swabs. The techniques employed in the Australian study (patients obtaining swabs while sitting or standing) would allow less access to the genital tract than our originally proposed squatting positions. In our study, the patient was advised first by a female nurse on the squatting position and locating the cervix. She was readvised on repeating the procedure and the attempt to take the swabs from the cervical surface. In our study, 86.7% of patients reported their ability to access the cervix (and, therefore, obtain high vaginal/cervical samples). The squatting position has the advantage of providing patients with the freedom to use both hands (one of which may be used to open the vulval lips). The technique is similar to that employed by women for self examination before the insertion of a cervical cap or for the presence of the intrauterine contraceptive device threads.
The new methods of information technology, with their declining cost, can provide extra support to the concept of self obtained samples with easier patient access to their results. The result of the tests may then be obtained by the patient by telephone (possibly via an automated service or a text message, using an identification code number). The procedure is already in use by the banking services for accessing personal and confidential information. It is possible to provide the sampling materials in a “test pack” that may be returned to a central laboratory, by post. The pack may include information and explanatory notes and a coded identification number. This would help to identify the patient’s samples, with confidentiality.
The recent escalation in the incidence of sexually transmitted infections, coupled with the increasing workload for GUM clinics is representing a challenge for adopting new ways in combatting the spread of sexually transmitted infections. The exploitation of new ideas, methods, and technologies could be of benefit, especially in areas out of access to advanced laboratory investigations (remote and rural areas). It could also be used as a supplementary method to current medical care (between visits) in special patient groups (for example, adolescents3 and sex industry workers6).
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