47. Pilot Study of Self-Collected Pharyngeal Testing for Chlamydia and Gonorrhea in the Setting of COVID19 Restrictions

Given that many youth and young adults utilize multiple orifices during sexual activity, testing for STIs from multiple anatomical sites can increase rates of diagnosis. However, during the COVID19 pandemic, obtaining oral swabs by clinical staff was deemed an unacceptable COVID19 transmission risk and was discontinued in our clinic. To circumvent this obstacle to diagnosis, clinic staff developed a workaround of obtaining patient collected pharyngeal swabs for STI testing. This abstract reviews the results of this pilot intervention. Patients presenting to an urban youth and young adult family planning/STI clinic who desired STI testing and ever engaged in oral sex were offered pharyngeal testing for chlamydia (CT) and gonorrhea (GC). Patients were instructed by nursing staff on how to obtain an oral sample, and subsequently sent outside of the clinic to obtain their individual sample. Chart review was conducted by clinic staff of a five month period during which this protocol was in place, and the following variables were collected: gender, sexual orientation, race/ethnicity, and STD testing results by anatomic site. Simple descriptive statistical analysis were used. 417 patients received a GC/CT test from > 1 anatomical site, with 83 patients having > 1 positive result. All pharyngeal samples were self-collected. Ten patients were positive for GC/CT from throat samples only (12% of positive tests). Three out of the ten identified as male. Six were biologically female, including one transgender FTM. Sexual orientation were 40% “straight”, 20% “gay”, 30% bisexual and 10% preferred not to answer. Reported race/ethnicity included four African-American, four white, 1 multiple races and one “Filipino”. Three of the positive patients considered themselves Hispanic. For comparison, of the overall subsample of patients with positive GC/CT results, patients identified as 58% female, 41% male, and 1% FTM; 65 “straight”, 11% bisexual, 19% “gay”, and 5% did not disclose; 34% white, 45% African-American, 12% unknown as other; and 30% Hispanic. Nineteen patients were positive for GC/CT from the throat and either rectum and/or urine/vagina/endocervix (23% of positive tests). Our experience demonstrates that obstacles created by the COVID19 crisis can be circumvented with creative strategies. Patients were receptive to self-collected pharyngeal samples, and we were able to pick up 12% and 23% of total infections by self-collected pharyngeal swabs in throat only and throat plus other sites, respectively.