Home Screening for Bacterial Vaginosis (BV) to Prevent Sexually Transmitted Diseases

BACKGROUND:

Longitudinal studies have consistently found a significant association between bacterial vaginosis (BV) and acquisition of sexually transmitted diseases (STDs). However, there is limited prospective data to confirm these findings.

METHODS:

We conducted a prospective, randomized, open-label trial of home screening and treatment of young women with asymptomatic BV who were also at high risk for STD. These women were screened every 2 months for 12 months and randomized to treatment with oral metronidazole 500 mg twice daily for 7 days versus observation alone. The primary outcome was the incidence of gonorrhea and/or chlamydia.

RESULTS:

1365 subjects were enrolled in the study across 10 sites. Adherence with mailing specimens obtained at home was excellent in both groups (84-88%). The incidence of gonorrhea and/or chlamydia was 19.1 per 100 person years (95% CI: 15.1-22.1) for the treatment group and 18.5 per 100 person-years (95% CI: 15.1-22.8) for the observation arm, a difference that was not statistically significant.

CONCLUSIONS:

Young women were very amenable to home screening for BV, gonorrhea, and chlamydia. Treatment of asymptomatic BV with one week of oral metronidazole did not result in a decreased incidence of gonorrhea and/or or chlamydia.

Purchase full article at:  http://goo.gl/ntrFhk

By:  Schwebke JR1, Lee JY2, Lensing S2, Philip SS3, Wiesenfeld HC4, Seña AC5, Trainor N3, Acevado N6, Saylor L6, Rompalo AM7, Cook RL8.

• 1Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
• 2Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR.
• 3San Francisco Department of Public Health, San Francisco, CA.
• 4Department of Obstetrics and Gynecology, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.
• 5Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
• 6Family Health International, Durham, NC.
• 7Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
• 8Departments of Epidemiology and Medicine, University of Florida, Gainesville, FL. 

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The Costs of Offering HPV-Testing on Self-Taken Samples to Non-Attendees of Cervical Screening in Finland

Offering self-sampling to non-attendees of cervical screening increases screening attendance.

We used observations from two Finnish studies on the use of self-sampling among the non-attendees to estimate in a hypothetical screening population of 100,000 women the possible costs per extra screened woman and costs per extra detected and treated CIN2+ with three intervention strategies; 1) a primary invitation and a reminder letter, 2) a primary invitation and a mailed self-sampling kit and 3) two invitation letters and a self-sampling kit. The program costs were derived from actual performance and costs in the original studies and a national estimate on management costs of HPV related diseases.

The price per extra participant and price per detected and treated CIN2+ lesion was lower with a reminder letter than by self-sampling as a first reminder. When self-sampling was used as a second reminder with a low sampler price and a triage Pap-smear as a follow-up test for HPV-positive women instead of direct colposcopy referral, the eradication of a CIN2+ lesion by self-sampling was not more expensive than in routine screening, and the addition of two reminders to the invitation protocol did not increase the price of an treated CIN2+ lesion in the entire screened population.

As a first reminder, a reminder letter is most likely a better choice. As second reminder, the higher costs of self-sampling might be compensated by the higher prevalence of CIN2+ in the originally non-attending population.

Full article at: http://goo.gl/qGSgbt

By: Anni Virtanen^1*, Ahti Anttila¹ and Pekka Nieminen²

¹Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki, FI-00130, Finland

²Department of Obstetrics and Gynecology, Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland

  

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