{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:12:38Z","timestamp":1789557158255,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"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\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["PB-PG-0212-27041"],"award-info":[{"award-number":["PB-PG-0212-27041"]}],"id":[{"id":"10.13039\/501100000272","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>Sexual history does not accurately identify those with extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), so universal extragenital sampling is recommended. Nucleic acid amplification tests (NAATs) are expensive. If urogenital, plus rectal and pharyngeal, samples are analyzed, the diagnostic cost is trebled. Pooling samples into 1 NAAT container would cost the same as urogenital samples alone. We compared clinician triple samples analyzed individually with self-taken pooled samples for diagnostic accuracy, and cost, in men who have sex with men (MSM) and females.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective, convenience sample in United Kingdom sexual health clinic. Randomized order of clinician and self-samples from pharynx, rectum, plus first-catch urine (FCU) in MSM and vulvovaginal swabs (VVS) in females, for NG and 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); 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx). There was no difference in sensitivities between clinician triple samples and self-pooled specimens for NG (99.1% and 98.3%), but clinician samples analyzed individually identified 3% more chlamydia infections than pooled (99.3% and 96.0%; P\u2005=\u2005.027). However, pooled specimens identified more infections than VVS\/FCU alone. Pooled specimens missed 2 NG and 11 CT infections, whereas VVS\/FCU missed 41 NG and 58 CT infections. Self-taken pooled specimens were the most cost-effective.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>FCU\/VVS testing alone missed many infections. Self-taken pooled samples were as sensitive as clinician triple samples for identifying NG, but clinician samples analyzed individually identified 3% more CT infections than pooled. The extragenital sampling was achievable at no additional diagnostic cost to the FCU\/VVS.<\/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\/ciaa1546","type":"journal-article","created":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T19:09:53Z","timestamp":1602356993000},"page":"e3183-e3193","source":"Crossref","is-referenced-by-count":25,"title":["Swab-Yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 2. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Rectal, Pharyngeal, and Urogenital Samples Analyzed Individually, Versus as a Pooled Specimen, 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 Services 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 Services 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 Services 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, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Imperial College London, 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 Services Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,12]]},"reference":[{"key":"2021110300245184500_CIT0001","article-title":"Global and regional estimates of the prevalence and incidence of four curable sexually transmitted infections in 2016","author":"Rowley","year":"2019","journal-title":"World Health Organization Bulletin"},{"key":"2021110300245184500_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 AIDS"},{"key":"2021110300245184500_CIT0003","author":"Fifer"},{"key":"2021110300245184500_CIT0004","author":"World Health 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Neisseria gonorrhoeae after routine universal urogenital and anorectal screening in women visiting the sexually transmitted infection clinic","volume":"64","author":"van Liere","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2021110300245184500_CIT0009","doi-asserted-by":"crossref","first-page":"5758387","DOI":"10.1155\/2016\/5758387","article-title":"Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature","volume":"2016","author":"Chan","year":"2016","journal-title":"Infect Dis Obstet Gynecol"},{"key":"2021110300245184500_CIT0010","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1136\/sextrans-2017-053161","article-title":"Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis","volume":"94","author":"Chandra","year":"2018","journal-title":"Sex Transm 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Belgium","volume":"75","author":"De Baetselier","year":"2020","journal-title":"Acta Clin Belg"},{"key":"2021110300245184500_CIT0016","first-page":"e01969","article-title":"Pooling pharyngeal, anorectal, and urogenital samples for screening asymptomatic men who have sex with men for Chlamydia trachomatis and Neisseria gonorrhoeae","volume":"8","author":"Durukan","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2021110300245184500_CIT0017","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/OLQ.0000000000001191","article-title":"To pool or not to pool samples for sexually transmitted infections detection in men who have sex with men? 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