Moreover, this preference was consistent across all age groups, even the youngest age group 16—19 years who are usually presumed to preclude intimate examinations because of embarrassment or discomfort. The conclusions from these two studies cannot be generalized as neither looked into the reason for such preferences or sought opinion beyond clinic attendance. Nevertheless they highlight the importance of educating patients about the limited evidence of the benefits of genital examination whilst stressing the effectiveness of self-sampling, in order to enable patients to make informed choices.
This systematic review identifies a lack of standardization for self-sampling methods, and the use of different analytic methods for STI detection and sampling procedures make it difficult to make any suggestion regarding what should be considered as the best self-sampling practice. The settings of the studies ranged from specialist centres to non-healthcare settings, with the majority of studies conducted in non-specialist healthcare settings.
However, as only a minority of the studies were conducted in such specialist settings, we believe that findings of this review are generalizable to wider settings. Rigorous attempts should be made to ensure the validity of these questionnaires.
The use of self-administered questionnaires with an open-ended option may be a preferable option. Some studies [ 30 ] [ 5 ] also gathered the opinions of participants who refused to self-sample which has highlighted some important potential negativities of self-sampling. Patients who did not accept the self-sampling offer are likely to have different opinions which were mainly undocumented.
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One might anticipate that socio-demographic and cultural factors would influence acceptance of and preferences for self-sampling. It is therefore, disappointing that not all studies collected comprehensive socio-demographic details. A certain degree of variability existed between studies conducted in different cultural and racial groups. Potential differences in opinion between ethnic groups have also been investigated by focus groups, where actual self-sampling did not take place.
For example, Forrest et al.
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Another focus group study by Howard et al [ 66 ] examined the barriers to self-sampling in six ethnic groups Afghani, Somali, Arabic, Chinese, Hispanic, and Canadian residing in Canada. In these studies, despite participants generally appreciating the benefits of self-sampling, all expressed a certain degree of reservation. However, this review is subject to a number of limitations. We did not include the studies published in language other than English which may have introduced bias in the findings of this review.
Nevertheless, this review did include studies from countries such as India, Thailand, and Brazil. In addition, cost-effectiveness of self-sampling was not addressed in this review. However, we noted that two studies looked at the cost per specimen received [ 26 , 54 ], one study calculated a net profit of self-testing over clinic-testing [ 38 ], and two studies looked at the cost that participants were willing to pay for self-sampling [ 3 , 33 , 67 ]. The anticipated cost for the health services is important for STI self- sampling and future studies need to conduct economic evaluations of self-sampling to develop an effective policy for the management of STIs.
In conclusion, despite the heterogeneity among studies, particularly of screening methods, populations studied, settings of self-sampling and methods of ascertaining acceptability, this systematic review has demonstrated that self-sampling is a well-accepted and preferred approach to test for STIs. Although, acceptance or preference for self-sampling does not necessarily reflect actual testing behaviour, this review suggests that self-sampling may be a feasible option for those who are hesitant to undergo clinician sampling.
We would like to express my thanks to Ms Jill Fairclough, Brighton and Sussex Medical School Librarian, for help and suggestions in formulating and performing the database search, especially in the early stage of the research. Conceived and designed the experiments: CL HS.
Performed the experiments: PP JL. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Routine screening is key to sexually transmitted infection STI prevention and control. Results The initial search yielded references.
Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review
Conclusion Self-sampling for diagnostic testing is well accepted with the majority having a positive experience and willingness to use again. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Data Availability: All relevant data are within the paper and its Supporting Information files. Funding: The authors have no support or funding to report.
Introduction Sexually transmitted infections STIs impose an enormous burden on sexual and reproductive health worldwide. Study selection, data extraction, and quality assessment Two reviewers PP and JL independently carried out the search, screened the titles of the articles and removed any irrelevant and duplicate articles. Download: PPT. Table 1. Summary of studies included in the systematic review. Results A total of references were initially identified from the computerized search but were excluded after screening the titles.
Outcome measures There were considerable variations in how acceptability and experience were measured and reported.
Acceptability and experience. Table 2. Ease of sampling. Pain and discomfort. Confidence in sampling and trust in test results. Concerns and worries. Demographic characteristics. What type of self-sampling? Clinic or home? Willingness to use or recommend of self-sampling? Reasons for Declining or Refusing to Self-Sample Sixteen studies recorded the reasons given by potential participants who refused to self-sample [ 3 , 5 , 16 , 17 , 22 , 25 , 27 , 31 , 35 , 36 , 39 , 40 , 44 , 49 , 52 , 58 ].
Supporting Information. S1 Table. S2 Table. Acknowledgments We would like to express my thanks to Ms Jill Fairclough, Brighton and Sussex Medical School Librarian, for help and suggestions in formulating and performing the database search, especially in the early stage of the research. References 1. WHO Sexually transmitted infections. Geneva: WHO. Sexually transmitted diseases — Mayaud P, Mabey D Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges.
Sexually transmitted infections — WHO Global incidence and prevalence of selected curable sexually transmitted infection Sexual health 1: — Health technology assessment Winchester, England iii—iv, ix—xii, 1— View Article Google Scholar J Obstet Gynaecol Can — Huynh J, Howard M, Lytwyn A Self-collection for vaginal human papillomavirus testing: systematic review of studies asking women their perceptions. Journal of lower genital tract disease — Mavedzenge S HIV self-testing among health workers: a review of the literature and discussion of current practices, issues and options for increasing access to HIV testing in Sub-Saharan Africa.
Geneva: World Health Organization. Sexual health — Preventive medicine — Archives of sexual behavior — Journal of Adolescent Health — A preliminary study. British Journal of Family Planning — Sexually transmitted infections 25— Holland-Hall C, Wiesenfeld H, Murray P Self-collected vaginal swabs for the detection of multiple sexually transmitted infections in adolescent girls.
Molecular methods in the laboratory diagnosis of sexually transmitted infections
Journal of pediatric and adolescent gynecology — Sexually transmitted infections 28— I: Acceptability of urine testing in primary and secondary healthcare settings. Sexually transmitted infections 16— Diagnostic microbiology and infectious disease — Sexually transmitted infections 60— A randomised controlled trial. Sexually transmitted diseases Obstetrics and gynecology Roth A, Rosenberger J, Reece M, Van Der Pol B Expanding sexually transmitted infection screening among women and men engaging in transactional sex: the feasibility of field-based self-collection.
BMJ open 3. Bmj — Journal of American College Health 46— Medical Journal of Australia Academic Emergency Medicine — Wayal S, Llewellyn C, Smith H, Fisher M Home sampling kits for sexually transmitted infections: preferences and concerns of men who have sex with men. BMC research notes 6: Chandeying V, Lamlertkittikul S, Skov S A comparison of first-void urine, self-administered low vaginal swab, self-inserted tampon, and endocervical swab using PCR tests for the detection of infection with Chlamydia trachomatis.
Sexual health 1: 51— Current opinion in infectious diseases Clinical infectious diseases — International Journal of Health Promotion and Education 40— Our search will include English and non-English databases. Our search will be limited to articles published since because of two factors: a the HC2 test is the most widely used HPV test worldwide and was first used in [ 14 ] and b the oldest currently available NAAT test reported in the literature for self-collected GC or CT was after [ 15 ].