Literature review > Issue_5 > Review on Tanksale et al. 

There has been a great deal of interest in the feasibility of using self collected specimens for diagnosis of STIs, particularly in rural populations for community based studies. [1-4]. Self collected samples would obviate the need for genital examinations in women who may be reluctant to participate; this would be very useful providing diagnostic accuracy using these specimens was not compromised. Tansake et al. report on a pilot study in a rural Indian population to evaluate the acceptability and reliability of using self collected vaginal swabs for diagnosis of Candida and BV. This evaluation took place in a gynaecological clinic alongside an evaluation of a newly designed structured examination protocol for findings of gynaecological examination.

The study was clearly defined as a pilot study and only 75 women were examined. The small numbers used were to give an indication of which methods could be used in a larger community based study and the paper demonstrates this whilst acknowledging small sample numbers. The women selected were attending the clinic and all patients were included, unless pregnant or postnatal, however 68% of these were vaginal discharge patients. All women were instructed by the gynaecologist how to take a self administered vaginal swab which they took and rolled onto a slide before any clinical examination and clinician samples were taken.

Results indicated a good concordance between two gynaecologists independently examining the women using the structured protocol, with kappa values ranging from 0.33, for external pallor to 1, external examination findings showing the least concordance. For the self administered swabs, 29 % of women preferred to collect their own swabs whilst 60% preferred them to be taken by the gynaecologist and 11% had no preference. There was a very good concordance for detection of both Candida and BV (Kappa 0.98) between self administered swabs and clinician taken swabs, with a prevalence of Candida of 29% and BV of only 3%.

The discussion focuses on the implications the pilot study has for further studies and the conclusions are that self administered swabs are acceptable in this population and did not compromise diagnosis of Candida or of BV. The structured protocol was also considered reliable for field study use. The authors also suggest that self administered swabs may be acceptable throughout India as previous studies had not been in the Indian subcontinent so no prior knowledge of degree of acceptability is available.

It is very important to evaluate using non intrusive sampling methods for acceptability and for diagnostic accuracy in different populations as these are far more acceptable for collecting data in epidemiological studies. Surprisingly only one third of the women in this study preferred self administered samples but this may be because this study was in a clinic population, the authors do add in the discussion that in a subsequent community study a much larger number of women preferred to self collect their samples. The other surprising finding is the low prevalence of BV in this clinic population at only 3%, verified by two independent slide readers; it will be interesting to see what the prevalence of BV is in the community study as it may be lower in an Indian population than reported from other developing countries. [5].

References:

1. Tabrizi SN, Fairley CK, Chen S, et al. Evaluation of patient-administered tampon specimens for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Trans Dis 200;27:133-7

2. Weisenfeld HC, Lowry DLB, Heine RP et al. Self collection of vaginal swabs for the detection of chlamydia, gonorrhoea and trichomonas. Sex Trans Dis 2001;28:321-5

3. Wilkinson D, Ndovela N, Kharsany N, et al. Tampon sampling for the diagnosis of bacterial vaginosis: a potentially useful way to detect genital infections? J Clin Microbiol 1997;35:2408-0

4. Sturm PDJ, Moodley P, Nzimande G et al. Diagnosis of bacterial vaginosis on self-collected tampon specimens. Inter J STD AIDS 2002;13:559-563.

5. West B, Morison L, Schim M, et al. Evaluation of a new rapid diagnostic kit (FemExam®) for bacterial vaginosis in patients with vaginal discharge syndrome in The Gambia. Sex Trans Dis 2003 30:483-490.

about SDI | newsletters | grants | publications | literature reviews

WHO Home - WHO Search - TDR Home - SDI Home - SDI Contact us
(c) WHO/OMS 2001