January 2, 2012
Volume 8 - Issue 1 

DynaMed Weekly Update

For the week ending December 28, 2012

Last week 335 articles were evaluated via DynaMed's Systematic Literature Surveillance and 101 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Self-Taken Vaginal Swab Tested by Nucleic Acid Amplification Detects More Chlamydia Infections Than Clinician-Obtained Endocervical Swab


Chlamydia is one of the most common sexually transmitted infections in women. Diagnostic samples may be obtained by clinicians during a pelvic examination, by urine sample, or by vaginal swabs taken by the patient. The optimal sampling method  is unclear. A recent cohort study compared the diagnostic performance of self-taken vaginal swabs and clinician-obtained endocervical swabs for detection of C. trachomatis infection. 


A total of 3,976 women ≥ 16 years old (35% asymptomatic) who were requesting testing for sexually transmitted infections took a self vulvovaginal swab prior to clinical examination. During examination, the clinician obtained an endocervical swab. Both swabs were tested using a nucleic acid amplification test (NAAT) designed to detect both chlamydia and gonorrhea. Any swab with a positive result of the first test was confirmed with a second NAAT specific for chlamydia. Chlamydia was diagnosed if either swab resulted in 2 positive test results.


C. trachomatis infection was detected in 10.3% of women. The detection rates were 97% for the self-taken vaginal swab and 88% for the clinician-obtained endocervical swab (p < 0.0001) (level 1 [likely reliable] evidence). Subgroup analyses of both symptomatic women and asymptomatic women showed nearly identical results to the overall analysis (BMJ 2012 Dec 12;345:e8013).


In a companion publication using the same samples and methodology, the two sampling approaches were compared for the detection of gonorrhea infections. Detection rates were 99% for self-taken vaginal swabs and 96% for endocervical swabs in overall analysis (not significant). In asymptomatic women, vaginal swabs had a 98% detection rate compared to 90% for the endocervical swabs (BMJ 2012 Dec 12;345:e8107).


For more information, see the Chlamydia genital infection and Gonococcal cervicitis topics in DynaMed.

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Medical uses of cannabinoids

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: January 2, 2012
Expiration Date: January 2, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives


Upon successful completion of this educational program, the reader should be able to:


1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.


Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


No commercial support has been received for this activity.

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ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.


Program ID: 1210392R

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