{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:22:45Z","timestamp":1792664565460,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100009128","name":"NIHR Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["PB-PG-0212-27041"],"award-info":[{"award-number":["PB-PG-0212-27041"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Urogenital testing misses extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Extragenital self-sampling is frequently undertaken despite no robust randomized, controlled trial evidence of efficacy. We compared clinician-taken rectal and pharyngeal samples with self-taken samples for diagnostic accuracy and cost in men who have sex with men (MSM) and in females.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective convenience sample from a UK sexual health clinic. We randomized the order of clinician- and self-taken samples from the pharynx and rectum, plus first catch urine (MSM) and vulvovaginal swabs (females), for NG\/CT detection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 9.4% infected females and 67.3% MSM were urogenital-negative. A total of 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx); 13.1% infected females and 71.8% MSM were urogenital-negative. Sexual history did not identify those with rectal infections. There was no difference in diagnostic accuracy between clinician- and self-taken samples from the rectum or pharynx. Clinicians took swabs more quickly than participants, so costs were lower. However, in asymptomatic people, nonqualified clinicians would oversee self-swabbing making these costs lower.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There was no difference in the diagnostic accuracy of clinician-taken compared with self-taken extragenital samples. Sexual history did not identify those with rectal infections, so individuals should have extragenital clinician- or self-taken samples. Clinician-taken swabs cost less than self-taken swabs; however, in asymptomatic people or those who perform home testing, the costs would be lower than for clinician-taken swabs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT02371109.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1266","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T11:11:43Z","timestamp":1598958703000},"page":"e3172-e3180","source":"Crossref","is-referenced-by-count":20,"title":["Swab-yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 1. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Clinician-taken vs Self-taken Rectal and Pharyngeal Samples for the Diagnosis of Gonorrhea and Chlamydia"],"prefix":"10.1093","volume":"73","author":[{"given":"Janet D","family":"Wilson","sequence":"first","affiliation":[{"name":"Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet E","family":"Wallace","sequence":"additional","affiliation":[{"name":"Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Loftus-Keeling","sequence":"additional","affiliation":[{"name":"Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Vargas-Palacios","sequence":"additional","affiliation":[{"name":"Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Hulme","sequence":"additional","affiliation":[{"name":"Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark H","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2021110300153147000_CIT0001","doi-asserted-by":"crossref","first-page":"548","DOI":"10.2471\/BLT.18.228486","article-title":"Global and regional estimates of the prevalence and incidence of four curable sexually transmitted infections in 2016","volume":"97","author":"Rowley","year":"2019","journal-title":"World Health Org Bull"},{"key":"2021110300153147000_CIT0002","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/0956462415615443","article-title":"2015 UK national guideline for the management of infection with Chlamydia trachomatis","volume":"27","author":"Nwokolo","year":"2016","journal-title":"Int J STD 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