Self-administered vaginal swabs are a feasible alternative to physician-assisted cervical swabs for sexually transmitted infection screening in the emergency department

Acad Emerg Med. 2009 Apr;16(4):360-3. doi: 10.1111/j.1553-2712.2009.00359.x. Epub 2009 Feb 11.


Background: Screening for sexually transmitted infections (STIs) in the emergency department (ED) is limited by the need for pelvic examination. It has been suggested that using self-administered vaginal swabs (SAVS) for this purpose may save time and resources and may be more comfortable for patients.

Objectives: The objective was to test the feasibility of using SAVS for STI screening in the ED.

Methods: This was a prospective study of female ED patients 18 to 55 years old who consented to physician-assisted cervical swab (PACS) and SAVS in two urban teaching hospitals. The ED personnel offered the test to all patients, whether or not a pelvic examination was indicated, based on their chief complaint. All specimens were analyzed by polymerase chain reaction (PCR) assay. Data are presented as mean +/- standard deviation (SD). Categorical data are presented as percentages with 95% confidence intervals (CIs). Patients with a positive test result for Chlamydia trachomatis and/or Neisseria gonorrhoeae were considered positive for STI. PACS were used as the criterion standard.

Results: One-hundred sixty-two subjects were enrolled from July 2006 to July 2007 (mean [+/-SD] age = 32 [+/-10] years). Eighty-one percent of patients had a genitourinary symptom (most common: vaginal bleeding/spotting). SAVS had a sensitivity of 91% (95% CI = 60% to 99%), specificity of 99% (95% CI = 95% to 99%), positive likelihood ratio of 91, and negative likelihood ratio of 0.09 in diagnosing STIs. None of the patients reported difficulty or discomfort using this technique.

Conclusions: Self-administered vaginal swabs can be utilized as a feasible alternative to PACS for STI screening in the ED.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Chlamydia trachomatis / isolation & purification
  • Diagnostic Tests, Routine / methods*
  • Emergency Service, Hospital
  • Female
  • Hospitals, Teaching
  • Humans
  • Middle Aged
  • Neisseria gonorrhoeae / isolation & purification
  • New York City / epidemiology
  • Physicians
  • Prospective Studies
  • Self Care / methods*
  • Sensitivity and Specificity
  • Sexually Transmitted Diseases / diagnosis*
  • Sexually Transmitted Diseases / epidemiology
  • Vaginal Diseases / diagnosis*
  • Vaginal Diseases / microbiology
  • Vaginal Smears / methods*
  • Vaginal Smears / statistics & numerical data
  • Young Adult