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Original research
Internet-based self-sampling for Chlamydia trachomatis testing: a national evaluation in Sweden
  1. Joakim Söderqvist1,
  2. Karolina Gullsby2,
  3. Lisa Stark3,
  4. Maria Wikman4,
  5. Roger Karlsson5,
  6. Bjőrn Herrmann1
  1. 1 Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  2. 2 Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
  3. 3 Department of Laboratory Medicine, County Hospital Ryhov, Jönköping, Sweden
  4. 4 Department of Virology, University of Umeå, Umeå, Sweden
  5. 5 Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
  1. Correspondence to Dr Bjőrn Herrmann, Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala 75185, Sweden; bjorn.herrmann{at}


Objective Internet-based testing for Chlamydia trachomatis (CT) with self-sampling at home has gradually been implemented in Sweden since 2006 as a free-of-charge service within the public healthcare system. This study evaluated the national diagnostic outcome of this service.

Methods Requests for data on both self-sampling at home and clinic-based sampling for CT testing were sent to the laboratories in 18 of 21 counties. Four laboratories were also asked to provide data on testing patterns at the individual level for the years 2013–2017.

Results The proportion of self-sampling increased gradually from 2013, comprising 22.0% of all CT tests in Sweden in 2017. In an analysis of 14 counties (representing 83% of the population), self-sampling increased by 115% between 2013 and 2017 for women, compared with 71% for men, while test volumes for clinic-based sampling were fairly constant for both sexes (1.8% increase for women, 15% increase for men). In 2017 self-sampling accounted for 20.3% of all detected CT cases, and the detection rate was higher than, but similar to, clinic-based testing (5.5% vs 5.1%). The proportion of self-sampling men was also higher, but similar (33.7% vs 30.8%). Analysis of individual testing patterns in four counties over 5 years showed a higher proportion of men using self-sampling only (67%, n=10 533) compared with women (40%, n=8885).

Conclusions Self-sampling has increased substantially in recent years, especially among women. This service is at least as beneficial as clinic-based screening for detection of CT, and self-sampling reaches men more than clinic-based testing.

  • chlamydia trachomatis
  • testing
  • microbiology
  • diagnostics

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  • Handling editor Claudia S Estcourt

  • Collaborators The Chlamydia Study Group represents the other 14 participating county laboratories in Sweden: Ann-Kristine Bergström, Marianne Bäckman, Karin Elfving, Helena Enroth, Lena Ericson, Hans Fredlund, Sultan Golbob, Marit Hansen, Håkan Janson, Malin Karlsson, Eva-Kristina Kinnunen, Helena Larsson, Marita Lindqvist, Anna Lindqvist Angervall, Annika Ljung, Lena Pizum, Helena Riise, Martin Sundqvist and Magnus Unemo.

  • Contributors BH designed and coordinated the study. Each participating laboratory represented in the study group contributed data. JS performed all data management and analyses. BH wrote the first draft of the manuscript, with support from JS. All authors, including the members of the study group, were involved in finalising the manuscript.

  • Funding This work was supported by grants from the Public Health Agency of Sweden.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref 2018/250).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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