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Review ArticleSystematic Review

Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis

Kristal J. Aaron, Stacey Griner, Alison Footman, Alexander Boutwell and Barbara Van Der Pol
The Annals of Family Medicine March 2023, 21 (2) 172-179; DOI: https://doi.org/10.1370/afm.2942
Kristal J. Aaron
1University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
DrPH, MSPH
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  • For correspondence: kjaaron@uabmc.edu
Stacey Griner
2University of North Texas Health Science Center School of Public Health, Fort Worth, Texas
PhD, MPH
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Alison Footman
3University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
PhD, MPH
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Alexander Boutwell
1University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
MA
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Barbara Van Der Pol
1University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
3University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
PhD, MPH
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  • Figure 1.
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    Figure 1.

    Prisma flowchart of included articles.

  • Figure 2.
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    Figure 2.

    Difference in assay sensitivity between vaginal swabs and urine in the detection of Chlamydia trachomatis.

    OR = odds ratio.

    a Non-calculable due to 100% sensitivity.

  • Figure 3.
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    Figure 3.

    Difference in assay sensitivity between vaginal swabs and urine in the detection of Neisseria gonorrhoeae.

    OR = odds ratio.

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    Figure 4.

    Difference in assay sensitivity between vaginal swabs and urine in the detection of Trichomonas vaginalis.

    OR = odds ratio.

    a Non-calculable due to 100% sensitivity.

Tables

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    Table 1.

    Characteristics of Studies Included in the Meta-Analysis

    First Author, YearPopulationOrganism StudiedIndex AssayQuality Reference Standard
    Wiesenfeld,35 1996STD clinic attendees at a health department in the USCTRoche Amplicor PCRCulture, alternate target NAAT
    Hjelm,22 2001Venereology department or Youth Health Clinic attendees at a university in SwedenCTAbbott LCRCulture, alternate target NAAT, multiple site NAAT positive
    Knox,18 2002Local clinic attendees in Australia requiring a pelvic examCT, NGRoche Amplicor PCRMultiple site Amplicor positives, alternate target NAAT
    Schachter,27 2003Army recruits entering basic training in the USCT(1) Abbott LCR
    (2) Roche Amplicor PCR
    (3) Hologic Amplified TMA/HPA CT
    Assay
    Culture multiple site NAAT positives
    Shrier,28 2004Those receiving routine gynecologic care at an outpatient facility in the USCTRoche Amplicor PCRCulture, multiple site NAAT positives, alternate target NAAT
    Schachter,9 2005Attendees of STD, OB/GYN, teen, and family planning clinics in the US and Canada.CT, NGHologic TMA/HPA AC2Multiple site NAAT positives alternate target NAAT
    Chernesky,20 2006Attendees of a street youth clinic or a sexual health awareness center in CanadaCT(1) Hologic TMA/HPA AC2
    (2) Roche Amplicor PCR
    (3) BD ProbeTec SDA
    Multiple site NAAT positives, alternate target NAAT
    Skidmore,29 2006Participants in the Chlamydia Screening Studies project in the UKCTRoche Amplicor PCR and BD ProbeTec SDAConfirmed by EIA, or alternate target NAAT
    Renton,25 2006Women presenting for termination of pregnancy in the UKCTAbbott LCRReferent is any direct fluorescent antibody, or Abbott LCR positive result
    Blake,17 2008Attendees at STD clinics in the USCTHologic TMA/HPA AC2Confirmed by alternate target NAAT
    Nye,40 2009Attendees at 1 STD clinic in the USTVHologic Aptima TMA/HPA TVMicroscopy, culture, an alternate target NAAT
    Schwebke,42 2011Attendees at US OB/GYN, family planning, or STD clinicsTVHologic Aptima TMA/HPA TVWet microscopy and culture
    Taylor,30 2011Attendees at US OB/GYN, family planning, or STD clinicsCTBD ProbeTec SDA2 alternate NAATs
    LeRoy,23 2012STD clinic attendees in Bordeaux, FranceCTBio-Rad Dx CT/NG/MG PCR assayAlternate target NAAT
    Van Der Pol,36 2012Attendees at US OB/GYN, family planning, or STD clinicsNGBD ProbeTec SDA2 alternate target NAATs
    Jang,38 2012Street youth clinic or community health center attendees in CanadaTVHologic Aptima TMA/HPA TVMultiple sites positive, alternate target NAAT
    Van Der Pol,32 2013Attendees at US OB/GYN, family planning, or STD clinicsCT, NGRoche Cobas PCR2 alternate target NAATs
    Gaydos,21 2013Sexually active symptomatic and asymptomatic women attending OB/GYN, STD, teen, public health, or family planning clinicsCT, NGCepheid CT/NG Xpert Rapid PCR Test2 alternate target NAATs
    Chernesky,19 2014Women attending sexual health centers in Hamilton and Toronto, Ontario, CanadaCT, NG(1) Hologic TMA/HPA AC2 on the Tigress
    (2) Hologic TMA/HPA AC2 on the Panther
    (3) Abbott RealTime CT/NG PCR
    (4) BD ProbeTec SDA
    (5) Roche Cobas PCR
    2 alternate NAATs
    Rumyantseva,26 2015Women that attended a Swedish STI clinic were invited to participateCTMultiplex RT AmpliSens N.gonorrhoeae/C.trachomatis/M.genitalium/T.vaginalis-Multiprime-FRT PCR assay2 alternate NAATs
    Van Der Pol,34 2017Attendees at US OB/GYN, family planning, or STD clinicsCT, NG, TVBD Max CT/GC/TV PCRMultiple site NAAT positives, alternate target NAAT for CT and NG; for TV, microscopy, culture and alternate target NAAT defined the composite infection standard.
    Gaydos,37 2017Attendees at US OB/GYN, family planning, or STD clinicsTVSolana TV HDA AssayMicroscopy and culture defined the composite infection standard; however, for samples that were positive by Solana® and negative by microscopy/culture, an alternate NAAT was used as a confirmation of a true positive.
    Schwebke,41 2018Attendees at US OB/GYN, family planning, or STD clinicsTVCepheid Xpert TV PCRCulture and alternate target NAAT
    Marlowe,39 2019Women from Germany, Ukraine, and US who were at risk of infection, or consulted a healthcare provider for TV screening, or were found to be positive for TV during routine testingTVRoche cobas TV/MG PCR3 alternate target NAATs
    Nye,24 2019Attendees at US OB/GYN, family planning, or STD clinicsCT, NGRoche cobas CT/NG PCR2 alternate target NAATs
    Van Der Pol,31 2019Attendees at US OB/GYN, family planning, or STD clinicsCT, NGRoche cobas CT/NG PCR2 alternate target NAATs
    Van Der Pol,43 2021Attendees at US OB/GYN, family planning, or STD clinicsTVRoche cobas TV/MG PCRCulture and alternate target NAAT
    Van Der Pol,33 2021Attendees at US OB/GYN, family planning, or STD clinicsCT, NG, TV(1) BD CTGCTV2 PCR
    (2) Hologic TMA/HPA AC2
    (3) BD ProbeTec SDA
    Multiple sites positive, alternate target NAATs
    • AC2 = aptima combo 2; BD = Becton, Dickinson and Company; CT = Chlamydia trachomatis; CTGCTV2 = BD MAX System assay; FRT = fluorescent resonance energy transfer ; GC = BD’s abbreviation for NG ; HDA = helicase-dependent amplification; HPA = hybridization protection assay; LCR = ligase chain reaction; MG = Mycoplasma genitaium; NAAT = nucleic acid amplification testing; NG = Neisseria gonorrhoeae; OB/GYN = obstetrics and gynecology; PCR = polymerase chain reaction; RT = real-time ; SDA = strand displacement amplification; STD = sexually transmitted disease; STI =sexually transmitted infection; TMA = transcription mediated amplification; TV = Trichomonas vaginalis; US = United States.

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The Annals of Family Medicine: 21 (2)
The Annals of Family Medicine: 21 (2)
Vol. 21, Issue 2
March/April 2023
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Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis
Kristal J. Aaron, Stacey Griner, Alison Footman, Alexander Boutwell, Barbara Van Der Pol
The Annals of Family Medicine Mar 2023, 21 (2) 172-179; DOI: 10.1370/afm.2942

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Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis
Kristal J. Aaron, Stacey Griner, Alison Footman, Alexander Boutwell, Barbara Van Der Pol
The Annals of Family Medicine Mar 2023, 21 (2) 172-179; DOI: 10.1370/afm.2942
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  • Risk factors for curable sexually transmitted infections among youth: findings from the STICH population survey in Zimbabwe
  • At-home specimen self-collection as an additional testing strategy for chlamydia and gonorrhoea: a systematic literature review and meta-analysis
  • Growing Evidence Supports an Implementation Shift Toward Vaginal Sampling for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis Screening
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Subjects

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    • Prevention
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Keywords

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Trichomonas vaginalis
  • women’s health

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