Charlotte A. Gaydos, PhD

Biography

Charlotte A. Gaydos, MS, MPH, Dr P.H.

Dr. Gaydos is an Associate Professor in the Division of Infectious Diseases, Department of Medicine of the Johns Hopkins University School of Medicine and has a joint appointment in Epidemiology and Population, Family and Reproductive Health at the Bloomberg Johns Hopkins School of Public Health. She is the Co-Director of the International Sexually Transmitted Diseases Research Laboratory. She received her B.S. in medical technology and her M.S. in medical microbiology from West Virginia University. Her M.P.H. and Dr.P.H. in Infectious Diseases andImmunology were received from Johns Hopkins University School of Hygiene and Public Health. Dr. Gaydos has extensive laboratory expertise with over 40 years experience in microbiology. She has authored 12 book chapters, over 160 research articles, and over 325 research abstracts and oral presentations. Dr. Gaydos has conducted many clinical trials for new diagnostics for C.trachomatis and Neisseria gonorrhoeae. She has worked the last 20 years in the STD research field performing original research developing DNA amplification tests for C. trachomatis, C. pneumoniae, C. psittaci, Trichomonas vaginalis, N. gonorrhoeae, Mycoplasma genitalium, and the agents of genital ulcer disease. An Internet project for enhanced community chlamydia screening using self-administered vaginal swabs, currently in progress, demonstrates an effective method for reaching women and men who may not attend clinics. Her laboratory has served as the Core Diagnostic Laboratory and as the Reference Laboratory for many national and international grants for collaborative studies of sexually transmitted diseases and trachoma. The laboratory is CLIA licensed and State of Maryland certified for diagnostic assays for chlamydia. Dr. Gaydos serves on the National Chlamydia Laboratory Committee, sponsored by the CDC.

Internet Recruitment of Self-obtained Genital Samples for Diagnosis of Sexually Transmitted Diseases: Present Success and Future Possibilities

Background

Although urine has historically been the traditional self-collected sample for diagnosis of sexually transmitted diseases (STDs), attention has now turned to collection of urogenital swabs as more convenient and more accurate diagnostic samples. These samples make it easy to access persons who are not attending clinics and must be tested by highly sensitive nucleic acid amplification tests (NAATs). Our objective was to use the Internet to recruit women to obtain self-obtained vaginal swabs (SOV) and men to submit self-collected male penile swabs and urine for the diagnosis of STDs, and measure the perception of the use of such sampling procedures. In Sweden, Internet recruited urine testing (N= 906) was highest in the 20-24 yr age group; more women (60%) participated than men (40%); less than 65% of ordered tests kits were returned, and prevalence was 4.6% in women and 6.0% in men.

Methods

www.iwantthekit.org was set up as an educational website which also recruited participants to request kits to obtain self-obtained urogenital specimens at home and mail them to a laboratory for testing. Females obtained SOV and males collected both urine and penile swabs.

Results

During the period of September 2006- February 2007, 231 requests from males and 480 from females have been received. Males submitted 13.9% of requested kits and females returned 34.2%. From a total of 822 females since 2004, prevalence observed was: chlamydia, 9.1%; gonorrhea, 1.2%; and trichomonas (n=158), 8.9%. In women 15-19 yr, the chlamydia prevalence was 16.9%. Multivariate analysis of 760 women indicated Black race, age <25 yr, using birth control, nonconsensual sex (protective) and multiple partners were all significantly associated with chlamydia infection. Of females, 96.0% rated collection of SOV easy/very easy, 98.2% rated instructions easy/very easy, and 93.5% would use the Internet method of SOV again. For males, Internet recruited self-collected penile swabs and urines have shown a chlamydia prevalence of 31.3%, with agreement of results between urine and penile swabs; no gonorrhea or trichomonas were detected. All but one male collected both urine and penile swabs. Median age was 23 yr. Prevalence by age indicated 15-24 yr had the highest prevalence (33.3%) vs. >25 yr (23.1%). By race, 62.1% were Black (prevalence, 33.3%) and 34.5% were White (prevalence, 20%) (p=ns). Of infected men, 100% stated they did not always use condoms vs. 65% of uninfected (p=0.053). Previous history for STD was 25%; 17.9% for chlamydia. Multiple partners were reported by 82.1%, new partner by 60.7%, anal sex by 32.1% and oral sex by 100%. No symptoms were reported by 76% of men, only 12% reported penile discharge, all uninfected; 8% reported painful urination. Of infected men, only 1 reported any symptoms. Questionnaire data indicated that 79.3% of men preferred to collect their own samples, 89.7% believed the method was safe, 86.2% would use the Internet method again; 55.2% preferred urine or penile sample vs. physician swab (31.0%).

Conclusions

Recruitment of participants to perform home sampling for STDs was possible via the Internet. Males do not seek self-collected STD screening with the same frequency as females. A high prevalence of chlamydia was detected and treatment of infected individuals was possible. Females were more likely to be positive for gonorrhea and trichomonas than men, but men demonstrated a higher prevalence for chlamydia. Self-obtained vaginal and penile swabs have the ability to open new venues for diagnosis of STDs.