Objectives To compare the accuracy (ie, correlation, sensitivity, specificity) of self-performed point-of-care (POC) tests with clinician-performed tests for trichomoniasis in adolescent women.
Methods Sexually experienced women aged 14–22 years (n=209) collected a vaginal swab and performed a POC test for trichomoniasis. Using a speculum, the clinician obtained vaginal swabs that were tested for trichomoniasis using the POC test, wet mount, culture and transcription-mediated amplification (TMA) using standard and alternative primers. Self and clinician results were compared with true positives, defined as either culture-positive or TMA-positive with both sets of primers.
Results Participants' mean age was 17.8 years; 87% were African-American; 74% reported vaginal itching or discharge and 51 (24%) had trichomoniasis. Over 99% correctly performed and interpreted her self-test. Self and clinician POC tests were highly correlated (95.7% agreement, κ 0.87). Compared with true positives, the sensitivity of the self-POC test was 78% (CI 65% to 89%), similar to that of the clinician-POC test (84%, CI 71% to 93%) and culture (82%, CI 69% to 92%), and significantly better than wet mount (39%, CI 26% to 54%). The specificity of the self-POC test was 99% (CI 96% to 100%), similar to that of the clinician-POC test (100%, CI 98% to 100%). The sensitivity of the self-POC test was not affected by vaginal symptoms or other variables.
Conclusions Young women performing a self-POC test detected as many trichomoniasis infections as clinician-POC tests or culture, twice as many as wet mount and slightly fewer than an amplified test. Incorporating self-obtained or self-performed POC tests into routine practice could effectively increase the identification and treatment of trichomoniasis in this vulnerable population.
- STD control
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Funding The study was supported by grant number 5K23AI063182-04 (JSH, PI) from the NIH/NIAID and by grant number 1U54EB007958-01 (CG, PI) from the NIH/NIBIB.
Competing interests JSH has received diagnostic kits, speaker's honoraria and unrestricted research funds from Genzyme Diagnostics, Inc. JSH and CG have received kits and reagents from Gen-Probe, Inc. JSH has received diagnostic kits from Gynex Corporation.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the Cincinnati Children's Hospital Medical Center's institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.
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