Question
Is rescreening for gonorrhea and chlamydial infections in a largely urban sexually transmitted disease population more successful if individuals are given the option of submitting a specimen for testing through the mail?
Design
This study describes a randomized trail to determine if rescreening efforts for gonorrhea and chlamydial infections in men and women treated at an urban STD clinic or hospital emergency department might be more successful if patients were given the option of rescreening through the mail rather than requiring that they go to an STD clinic.
Participants
One hundred twenty-two heterosexual patients who were at least 14 years old and diagnosed with genital C. trachomatis or N. gonorrhoeae infection at the Public Health-Seattle and King County STD clinic or the Harborview Medical Center Emergency Department were enrolled beginning 10 weeks after treatment. Sixty-two were randomly assigned to clinic rescreening and 60 were given the option of either mailing a specimen for testing or going to a clinic for rescreening. Patients were excluded due to residence outside of King County, previous retesting at least 6 weeks after treatment, ongoing incarceration or residence in a drug treatment facility, inability to speak English, need for rectal rescreening, or previous study enrollment.
Description of Tests and Diagnostic Standard
Participants were randomized to either go to the STD clinic to provide a urine specimen with or without a free physical examination according to the patient’s preference (n = 62) or the choice of either rescreening at the clinic or mailing a specimen to the clinic for testing (n = 60). Women were provided with a swab and tube for a self-obtained vaginal swab. Men were sent a 30-mL tube for urine collection. All specimens were tested for C. trachomatis and N. gonorrhoeae by the CT/NG Cobas Amplicor PCR test (Roche Diagnostics, Branchburg, NJ) according to the manufacturer’s instructions. After 28 days, individuals who did not return to the clinic or mail a specimen were recontacted and offered the option of either mailing a specimen or going to the clinic.
Main Outcome Measures
The proportion of subjects in each rescreening group who were rescreened was determined.
Main Results
Forty-two (70%) of the 60 subjects randomized to the mailing option chose clinic retesting. Age, race, gender, and STD diagnoses did not significantly differ for those who elected to mail a specimen versus those who chose to go to the clinic. Patients in the mailing option group were more likely to be rescreened within 28 days of enrollment than patients in the clinic rescreening group (OR = 1.7, 95% CI = 0.8-3.8). The rescreening rates for the two groups are shown in the table. Patients who were rescreened were older than those who were not (P = 0.01) but did not differ by race or gender.
Rescreening outcomes for each STD rescreening group
|
Outcome
|
Number with outcome/total (%)
|
| |
Clinic group
(n = 62)
|
Mail or clinic option group (n = 60)
|
|
Rescreened within 28 days of enrollment
|
20/62 (32)
|
27/60 (45)
|
|
Reminded after 28, subsequently came to clinic
|
6/22 (27)
|
3/16 (19)
|
|
Reminded after 28, subsequently mailed in specimen
|
6/7 (86)
|
2/16 (13)
|
|
Unable to remind, came to clinic after 28 days
|
3/13 (23)
|
3/13 (23)
|
|
Unable to remind, mailed in specimen after 28 days
|
Not applicable
|
1/4 (25)
|
|
Total number rescreened
|
35/62 (56)
|
36/60 (60)
|
Authors’ Conclusions
The majority of STD clinic patients preferred to return to the clinic for rescreening. Most patients who agreed to mail a specimen for rescreening did so. The study sample size was inadequate to definitively compare the two options. Despite this limitation, the increased rescreening in the group who chose to mail a specimen suggests that this method will be a successful alternative to clinic rescreening.
Source of funding: Grants from the National Institutes for Health, National Cancer Institute, and Roche Molecular Diagnostics.
For correspondence: Matthew R. Golden, Center for AIDS and STD, Harborview Medical Center, Box 359777, 325 9th Ave., Seattle, WA 98104. E-mail address: HYPERLINK mailto:golden@u.washington.edu golden@u.washington.edu.
.gif){kind=small}