Two methods of self-sampling compared to clinician sampling to detect reproductive tract infections in Gugulethu, South Africa

Objectives: To assess the validity, feasibility, and acceptability of 2 methods of self-sampling compared to clinician sampling during a speculum examination. Goal: To improve screening for reproductive tract infections (RTIs) in resource-poor settings. Study Design: In a public clinic in Cape Town, 450 women underwent a speculum examination and were randomized to self-sample with either a tampon or vaginal swabs. All specimens were tested for the same pathogens using the same diagnostic tests. Results: Self-sampling resulted in satisfactory validity for N gonorrhoeae, C trachomatis, bacterial vaginosis, and Candida species (tampons and swabs) and high-risk human papillomavirus (swabs only) when tested with molecular tests or microscopy, but not for T vaginalis by culture. Self-sampling was feasible and acceptable, but some women preferred speculum examinations, which allow the clinician to view the vagina and cervix. Conclusions: Although self-sampling should not replace speculum examinations in all circumstances, it should be explored further as an RTI screening strategy.