155. Adolescents Chose Vaginal Swabs Over Urine Sample for Chlamydia Screening When Recommended by Physician

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The Centers for Disease Control (CDC) and the United States Preventive Services Task Force recommend annual screening for Chlamydia trachomatis in sexually active young women. Specimens obtained with a vaginal swab are more sensitive than specimens obtained from urine, and are recommended by the CDC[1]. Patient-collected vaginal swabs are equal in sensitivity and specificity to clinician-obtained samples[2][3]. Acceptability of vaginal swabs, and specifically patient-collected vaginal swabs, in adolescents in the United States is unknown. We performed a retrospective chart review for patients seen between January 2013 and July 2014 at an urban adolescent clinic in central New York State. Females who agreed to screening for Chlamydia trachomatis, who did not require a pelvic exam at that visit, and who were offered the choice of Chlamydia screening with either a vaginal swab or urine sample were included. Patients who were screened more than once during the study period were included only on the initial visit. By clinic protocol, patients were informed by their physician that Chlamydia screening using a vaginal swab was recommended. Patients were then offered the choice between a provider-administered vaginal swab, a self-administered vaginal swab, or a urine test. We documented which method each patient chose, and we also recorded patient age in years. This study was granted an exemption by our IRB. A total of 1,120 charts were reviewed and 79 patients were eligible for the study. The age range of included patients was 13 to 21 years (average 17 years). Overall, 58 patients (73%) chose a vaginal swab, versus 21 patients who chose to provide a urine sample (p=0.00). Of those patients who selected screening with a vaginal swab, 40 of the 58 patients (69%) opted to self-administer the vaginal swab (p=0.00). There was no significant age difference in patients choosing self-collected versus provider-collected specimens. When recommended by a physician, adolescents in this review preferentially chose vaginal swabs over providing a urine sample for Chlamydia screening. However, more than one quarter of the adolescents in this study still chose to provide a urine sample, indicating that screening via urine should still be available in order to avoid a decrease in screening rates, particularly in younger adolescents. Over half of the patients who chose a vaginal swab also chose to self-administer the swab.