{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:21:15Z","timestamp":1753885275948,"version":"3.37.3"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000085","name":"Ontario HIV Treatment Network","doi-asserted-by":"publisher","award":["EFP-2020-DC1"],"award-info":[{"award-number":["EFP-2020-DC1"]}],"id":[{"id":"10.13039\/501100000085","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The rates of gonorrhea and chlamydia have been increasing in the years preceding the COVID19 pandemic. Because most gonorrhea and chlamydia infections are located in the oropharynx and rectum for men who have sex with men (MSM), and because at-home self-collected swabs for these infections are not licensed by Health Canada or the United States Food and Drug Administration, decreased accessed to in-person care during and since the COVID19 pandemic potentially means missed case findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To evaluate the performance of at-home self-collected pharyngeal and rectal swabs for gonorrhea and chlamydia nucleic acid amplification testing.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>All persons who contacted our Sexual Health Clinic and who had a clinical indication to complete oral and\/or rectal swabs for gonorrhea and chlamydia were invited to complete at-home swabs in advance of their scheduled appointments. We mailed swabs and instructions to those who consented. Participants brought these swabs to their scheduled in clinic appointments, where we repeated the same swabs. All matching swabs were sent to the laboratory for analysis to determine concordance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>From September 8, 2022 to July 18, 2023, we enrolled 296 eligible participants who provided 1184 swabs. For analysis, cancelled specimens and specimens with invalid results were excluded, leaving 1032 swabs for comparison. We identified 66 STI diagnoses in 47 unique participants. Overall accuracy was high (exceeding 99%), except for rectal chlamydia, which was 96.0%. While the performance of self-swabs for chlamydia was lower compared to gonorrhea, at-home swabs identified six chlamydia infections that were missed by in-clinic collected swabs (two pharyngeal, four rectal). Removing these six cases as \u201cfalse positives\u201d increased overall accuracy for chlamydia detection to 99.7% (pharyngeal) and 97.8% (rectal).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Self-collected at-home swabs had good performance acceptable for gonorrhea and chlamydia nucleic acid amplification testing.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302785","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T17:37:48Z","timestamp":1716226668000},"page":"e0302785","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Testing for extragenital Neisseria gonorrhoeae and Chlamydia trachomatis: At-home pharyngeal and rectal self-swabs are non-inferior to those completed in healthcare settings"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-2866","authenticated-orcid":true,"given":"Lauren","family":"Orser","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Tran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0587-1409","authenticated-orcid":true,"given":"Patrick","family":"O\u2019Byrne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail","family":"Kroch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Bonnetsmueller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maan","family":"Hasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Musten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"journal-title":"Sexually transmitted and blood-borne infections: Guides for health professionals.","year":"2023","author":"Public Health Agency of Canada","key":"pone.0302785.ref001"},{"journal-title":"Chlamydia in Ontario: January 1, 2019-December 31, 2021.","year":"2023","author":"Public Health Ontario","key":"pone.0302785.ref002"},{"journal-title":"Gonorrhea in Ontario: January 1, 2019-December 31, 2021.","year":"2023","author":"Public Health Ontario","key":"pone.0302785.ref003"},{"journal-title":"Survey on the impact of COVID-19 on the delivery of STBBI prevention, testing and treatment, including harm reduction services, in Canada.","year":"2023","author":"Public Health Agency of Canada","key":"pone.0302785.ref004"},{"issue":"7","key":"pone.0302785.ref005","first-page":"554","article-title":"Approach to lymphogranuloma venereum.","volume":"62","author":"P O\u2019Byrne","year":"2016","journal-title":"Can Fam Physician"},{"key":"pone.0302785.ref006","first-page":"1","article-title":"Changes in inflammatory cytoking levels in rectal mucosa associated with Neisseria gonorrhea and\/or Chlamydia trachomatis infection and treatment among men who have sex with men in Lima, Peru","volume":"349","author":"JL Clark","year":"2023","journal-title":"J Infect Dis"},{"issue":"7","key":"pone.0302785.ref007","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/OLQ.0000000000000614","article-title":"New HIV diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men.","volume":"44","author":"LA Barbee","year":"2017","journal-title":"Sex Transm Dis"},{"issue":"14","key":"pone.0302785.ref008","first-page":"321","article-title":"Extragenital chlamydia and gonorrhea among community-venue attending MSM\u2013Five cities, United States, 2017.","volume":"68","author":"ML Johnson Jones","year":"2019","journal-title":"MMWR"},{"issue":"9","key":"pone.0302785.ref009","doi-asserted-by":"crossref","first-page":"285","DOI":"10.14745\/ccdr.v46i09a06","article-title":"Extragenital testing increases case detection of gonorrhea and chlamydia: The impact of implementing nucleic acid amplification testing.","volume":"46","author":"DS Friedman","year":"2020","journal-title":"Can Commun Dis Rep"},{"issue":"7","key":"pone.0302785.ref010","doi-asserted-by":"crossref","first-page":"e0132776","DOI":"10.1371\/journal.pone.0132776","article-title":"Self-collected versus clinician-collected sampling for chlamydia and gonorrhea screening: A systematic review and meta-analysis.","volume":"10","author":"C Lunny","year":"2015","journal-title":"PLoS One"},{"issue":"9","key":"pone.0302785.ref011","first-page":"e01215","article-title":"Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men","volume":"58","author":"EPF Chow","year":"2020","journal-title":"J Clin Microbiol"},{"journal-title":"Chlamydia trachomatis \/ Neisseria gonorrhoeae (CT\/NG)\u2013Nucleic Acid Amplification Testing (NAAT).","year":"2023","author":"Public Health Ontario","key":"pone.0302785.ref012"},{"journal-title":"Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).","year":"2023","author":"Roche","key":"pone.0302785.ref013"},{"journal-title":"Cobas\u00ae CT\/NG Qualitative nucleic acid test for use on the cobas\u00ae 6800\/8800 Systems.","year":"2023","author":"Roche","key":"pone.0302785.ref014"},{"key":"pone.0302785.ref015","first-page":"p555","volume-title":"Sexually Transmitted Diseases","author":"J Schachter","year":"2008","edition":"4"},{"issue":"6","key":"pone.0302785.ref016","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1038\/nrmicro.2016.30","article-title":"Chlamydia cell biology and pathogenesis","volume":"14","author":"C Elwell","year":"2016","journal-title":"Nat Rev Microbiol"},{"issue":"7","key":"pone.0302785.ref017","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1007\/s10461-020-02894-2","article-title":"Characterizing the impact of COVID-19 on men who have sex with men across the United States in April, 2020.","volume":"24","author":"TH Sanchez","year":"2020","journal-title":"AIDS Behav"},{"issue":"9","key":"pone.0302785.ref018","doi-asserted-by":"crossref","first-page":"e3172","DOI":"10.1093\/cid\/ciaa1266","article-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 versus self-taken rectal and pharyngeal samples for the diagnosis of gonorrhoea and chlamydia","volume":"73","author":"JD Wilson","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pone.0302785.ref019","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1136\/sextrans-2021-055361","article-title":"High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations.","volume":"98","author":"RD Assaf","year":"2022","journal-title":"Sex Transm Infect"},{"issue":"12","key":"pone.0302785.ref020","doi-asserted-by":"crossref","first-page":"e8504","DOI":"10.1371\/journal.pone.0008504","article-title":"Denial of risk behaviour does not exclude asymptomatic anorectal sexually transmitted infection in HIV-infected men.","volume":"4","author":"ER Cachay","year":"2009","journal-title":"PLoS One"},{"issue":"7","key":"pone.0302785.ref021","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/OLQ.0000000000001803","article-title":"High prevalence of rectal chlamydia and gonorrhea among men who have sex with men who do not engage in receptive anal sex.","volume":"50","author":"CM Khosropour","year":"2023","journal-title":"Sex Transm Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302785","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T17:38:09Z","timestamp":1716226689000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302785"}},"subtitle":[],"editor":[{"given":"Mengistu Hailemariam","family":"Zenebe","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,20]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302785","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,5,20]]}}}