Changing from clinician-collected to self-collected throat swabs for oropharyngeal gonorrhoea and chlamydia screening among men who have sex with men.

Chow, Eric P F; Bradshaw, Catriona S; Williamson, Deborah A; Hall, Shauna; Chen, Marcus Y; Phillips, Tiffany R; Fortune, Ria; Maddaford, Kate; Fairley, Christopher K

The coronavirus (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was primarily used for genital and anorectal infections with only limited studies on the performance of self-collected oropharyngeal swabs for oropharyngeal STIs. Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhoea and chlamydia screening on March 16, 2020 to reduce healthcare worker risk during the COVID-19 pandemic. We compared the proportion of valid and positive samples for gonorrhoea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician-collected period between January 20 and March 15, 2020; and the self-collected period between March 16 and May 8, 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for N. gonorrhoeae was higher in the self-collected period (1.6% [24/1,497]) compared to the clinician-collected period (0.9% [23/2,600]) (p=0.038) but did not differ for the detection of C. trachomatis The positivity of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio (PR) 1.09; 95% CI: 0.87 to 1.37; p=0.435) and oropharyngeal C. trachomatis (adjusted PR 0.84; 95% CI: 0.51 to 1.39; p=0.504) did not differ between the two periods. Self-collected oropharyngeal swabs for detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and importantly reduce healthcare worker exposure to respiratory infection.