Preliminary Evaluation of Home-Based Rapid Tests versus Standard Laboratory Diagnostics for Common Sexually Transmitted Infections in a Conservative Cultural Setting: A Pilot Cross-Sectional Study
DOI:
https://doi.org/10.21928/uhdjst.v10n2y2026.pp122-133Keywords:
Sexually Transmitted Infections, Home-Based Rapid Diagnostic Tests, Conservative Culture, Cross-Sectional Study, Chlamydia, Gonorrhea, TrichomoniasisAbstract
Many sexually transmitted infections (STIs), such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV), frequently progress without symptoms, which can lead to missed diagnoses and untreated cases with serious health effects. Home-based rapid diagnostic tests offer a private and convenient option compared to clinic visits, especially in places where stigma and privacy concerns make it challenging to access care. In this pilot cross-sectional study, we worked with 33 individuals (20 community participants and 13 hospital-referred patients) from the Kurdistan Region of Iraq. They collected their swab and urine samples, which were tested at home for CT, NG, and TV. We compared these results to standard hospital-based nucleic acid amplification tests and calculated measures such as sensitivity, specificity, predictive values, and Cohen’s kappa coefficient (κ). The prevalence rates were 9.1% (3/33) for CT, 6.1% (2/33) for NG, and 4.2% (1/24 females) for TV, as only females were eligible for TV testing according to the manufacturer’s instructions. Home-based testing for CT matched hospital results exactly (all metrics 100%; κ = 1.0). For NG, home-based testing achieved 100% sensitivity and negative predictive value (NPV), 96.8% specificity, 66.7% positive predictive value (PPV), 97.0% accuracy, and κ = 0.786, showing strong agreement with one false-positive result. For TV, sensitivity and NPV were 100%, specificity was 95.7%, PPV was 50.0%, overall accuracy was 95.8%, and κ = 0.65, also showing strong agreement. This investigation is the first study in the Kurdistan Region to compare home-based STI rapid tests with hospital diagnostics, and the findings support their potential as a reliable and culturally acceptable complement to clinic-based screening. Larger population-based studies are needed to confirm these results and guide the integration of home-based STI testing in public health strategies.
References
M. Díez and A. Díaz. “Sexually transmitted infections: Epidemiology and control”. Revista Espanola De Sanidad Penitenciaria, vol. 13, no. 2, pp. 58-66, 2011.
J. Sharifi-Rad, C. Quispe, A. Rahavian, J. Carneiro, J. E. Rocha, A. L. A. Borges Leal, M. F. B. Morais Braga, H. Coutinho, A. A. Djafari, P. Alarcon-Zapata, M. Martorell, G. Antika, T. Boyunegmez Tumer and D. Calina. “Bioactive compounds as potential agents for sexually transmitted diseases management: A review to explore molecular mechanisms of action”. Frontiers in Pharmacology, vol. 12, p. 674682, 2021.
M. R. Garcia, S. W. Leslie and A. A. Wray. “Sexually transmitted infections”. In: StatPearls. StatPearls Publishing, Treasure Island, FL, 2025.
A. De Schryver and A. Meheus. “Epidemiology of sexually transmitted diseases: The global picture”. Bull World Health Organ, vol. 68, no. 5, pp. 639-654, 1990.
WHO. “Sexually Transmitted Infections (Stis)”. World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) [Last accessed on 2023 Nov 18].
M. Unemo, M. M. Lahra, M. Escher, S. Eremin, M. J. Cole, P. Galarza, F. Ndowa, I. Martin, J. A. R. Dillon, M. Galas, P. Ramon-Pardo, H. Weinstock and T. Wi. “WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: A retrospective observational study”. The Lancet Microbe, vol. 2, no. 11, pp. e627-e636, 2021.
H. W. Chesson, P. Mayaud and S. O. Aral. “Sexually Transmitted infections: Impact and Cost-Effectiveness of Prevention”. The World Bank, Washington, DC, 2017.
Hologic Inc. “Aptima Combo 2® Assay (Panther® System)”. Hologic, United States, 2017.
C. Springer and P. Salen. “Gonorrhea”. StatPearls Publishing, Florida, 2020.
L. K. Ng and I. E. Martin. “The laboratory diagnosis of Neisseria gonorrhoeae”. Canadian Journal of Infectious Diseases and Medical Microbiology, vol. 16, no. 1, pp. 15-25, 2005.
J. A. Schumann and S. Plasner. “Trichomoniasis”. StatPearls Publishing, Treasure Island, FL, 2023.
O. T. Van Gerwen, S. A. Opsteen, K. J. Graves and C. A. Muzny. “Trichomoniasis”. Infectious Disease Clinics of North America, vol. 37, no. 2, pp. 245-265, 2023.
Hologic Inc. “Aptima™ Trichomonas vaginalis Assay package insert”. 2017. Available from: https://www.hologic.com/sites/ default/files/package-insert/503797-IFU-PI_002_01.pdf [Last accessed on 2025 Sep 18].
F. M. Wagenlehner, N. H. Brockmeyer, T. Discher, K. Friese and T. A. Wichelhaus. “The presentation, diagnosis, and treatment of sexually transmitted infections”. Deutsches Ärzteblatt International, vol. 113, no. 1-2, pp. 11-22, 2016.
M. Balfe, R. Brugha, D. O’Donovan, E. O’Connell and D. Vaughan. “Triggers of self-conscious emotions in the sexually transmitted infection testing process”. BMC Research Notes, vol. 3, no. 1, p. 229, 2010.
G. Al-Gburi, A. Al-Shakarchi, J. D. Al-Dabagh and F. Lami. “Assessing knowledge, attitudes, and practices toward sexually transmitted infections among Baghdad undergraduate students for research-guided sexual health education”. Frontiers in Public Health, vol. 11, p. 1017300, 2023.
J. Y. Lebni, S. F. Irandoost, A. A. Dehghan, A. Ziapour, B. Khosravi and N. Mehedi. “Exploring the reasons for women to engage in sex work in Tehran, Iran: A qualitative study”. Heliyon, vol. 7, no. 12, p. e08512, 2021.
C. Elendu, D. C. Amaechi, I. D. Elendu, T. C. Elendu, E. C. Amaechi, E. U. Usoro, N. L. Chima-Ogbuiyi, D. B. Arrey Agbor, C. J. Onwuegbule, E. F. Afolayan and B. B. Balogun. “Global perspectives on the burden of sexually transmitted diseases: A narrative review”. Medicine (Baltimore), vol. 103, no. 20, p. e38199, 2024.
H. Y. Kim. “Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test”. Restorative Dentistry and Endodontics, vol. 42, no. 2, p. 152, 2017.
M. L. McHugh. “The chi-square test of independence”. Biochemia Medica (Zagreb), vol. 23, no. 2, pp. 143-149, 2013.
D. G. Altman. “Practical Statistics for Medical Research”. Chapman and Hall/CRC, United States, 1990.
M. L. McHugh. “Interrater reliability: The kappa statistic”. Biochemia Medica (Zagreb), vol. 22, no. 3, pp. 276-282, 2012.
J. R. Landis and G. G. Koch. “The measurement of observer agreement for categorical data”. Biometrics, vol. 33, pp. 159-174, 1977.
S. L. Shih, A. S. Graseck, G. M. Secura and J. F. Peipert. “Screening for sexually transmitted infections at home or in the clinic?” Current Opinion in Infectious Diseases, vol. 24, no. 1, pp. 78-84, 2011.
B. M. Birhane, A. Simegn, W. A. Bayih, E. S. Chanie, B. Demissie, Z. M. Yalew, H. Alemaw and D. M. Belay. “Self-reported syndromes of sexually transmitted infections and its associated factors among reproductive (15-49 years) age women in Ethiopia”. Heliyon, vol. 7, no. 7, p. e07524, 2021.
A. S. Graseck, G. M. Secura, J. E. Allsworth, T. Madden and J. F. Peipert. “Home compared with clinic-based screening for sexually transmitted infections: A randomized controlled trial”. Obstetrics and Gynecology, vol. 116, no. 6, pp. 1311-1318, 2010.
L. Fajardo-Bernal, J. Aponte-Gonzalez, P. Vigil, E. Angel-Müller, C. Rincon, H. G. Gaitán and N. Low. “Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections”. Cochrane Database of Systematic Reviews, vol. 9, no. 9, p. CD011317, 2015.
Z. Khan, A. Bhargava, P. Mittal, R. Bharti, P. Puri, N. Khunger and M. Bala. “Evaluation of reliability of self-collected vaginal swabs over physician-collected samples for diagnosis of bacterial vaginosis, candidiasis and trichomoniasis, in a resource-limited setting: A cross-sectional study in India”. BMJ Open, vol. 9, no. 8, p. e025013, 2019.
Z. N. Jaya, W. Mapanga, B. Van Niekerk, T. Dlangalala, K. Kgarosi, M. Dzobo, D. Mulqueeny and T. P. Mashamba-Thompson. “Mapping evidence of self-sampling to diagnose sexually transmitted infections in women: A scoping review”. Diagnostics (Basel), vol. 12, no. 8, p. 1803, 2022.
Z. Jaya, W. Mapanga, T. Dlangalala, N. Thembane, K. Kgarosi, and T. Dzinamarira. “Accuracy of self-collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections in females: An updated systematic review and meta-analysis”. Scientific Reports, vol. 14, no. 1, p. 10496.
K. A. Workowski, L. H. Bachmann, P. A. Chan, C. M. Johnston, C. A. Muzny, I. Park, H. Reno, J. M. Zenilman and G. A. Bolan. “Sexually transmitted infections treatment guidelines, 2021”. MMWR Recommendations and Reports, vol. 70, no. 4, pp. 1-187, 2021.
R. B. Ali and K. K. Ghaima. “Molecular detection of some sexually transmitted bacteria and Trichomonas vaginalis in Iraqi married couples”. Iraqi Journal of Biotechnology, vol. 21, no. 2, pp. 76-84, 2022.
I. Y. Mansoor. “Prevalence of Gonorrhea among adult male with urethritis in Erbil City”. Zanco Journal of Medical Sciences, vol. 18, no. 2, pp. 692-696, 2014.
S. S. Ismael. “Prevalence of Trichomoniasis and Vulvovaginal candidiasis among married women in Duhok City, Kurdistan Region, Iraq”. Archives of Razi Institute, vol. 79, no. 2, pp. 303-306, 2024.
M. Adil Murad, S. A. Ibrahim and A. Y. Mahmood. “Distribution and risk factors of Trichomonas vaginalis infection with relevance to interleukin profile among population in Duhok city, Iraq”. Clinical Epidemiology and Global Health, vol. 30, p. 101784, 2024.
D. G. Altman and J. M. Bland. “Statistics notes: Diagnostic tests 2: Predictive values”. BMJ, vol. 309, no. 6947, p. 102, 1994.
M. T. Ha, T. L. Pham, T. A. Nguyen and V. T. Le. “Performance of antigen-based rapid test for Chlamydia trachomatis in comparison with polymerase chain reaction test”. Medicina Clínica Práctica, vol. 7, no. 3, p. 100447, 2024.
R. Powell, H. M. Pattison and J. F. Marriott. “Perceptions of self-testing for Chlamydia: understanding and predicting self-test use”. Healthcare, vol. 4, no. 2, p. 25, 2016.
W. H. Su, T. S. Tsou, C. S. Chen, T. Y. Ho, W. L. Lee, Y. Y. Yu, T. J. Chen, C. H. Tan and P. H. Wang. “Diagnosis of Chlamydia infection in women”. Taiwanese Journal of Obstetrics and Gynecology, vol. 50, no. 3, pp. 261-267, 2011.
T. A. Peterman, K. Kreisel, M. A. Habel, W. S. Pearson, P. J. Dittus, and J. R. Papp. “Preparing for the chlamydia and gonorrhea self-test”. Sexually Transmitted Infection, vol. 45, no. 3, pp. e7-e9, 2018.
Z. Lei, Y. Feng and Z. Junzhe. “Performance evaluation of the Chlamydia Rapid test for qualitative detection of Chlamydial antigens in clinical diagnosis”. MEDS Clinical Medicine, vol. 5, no. 1, pp. 158-163, 2024.
R. P. Peters, J. D. Klausner, L. Mazzola, M. M. Mdingi, H. Jung, R. M. S. Gigi, J. Piton, J. Daniels, L. De Vos, P. C. Adamson, B. Gleeson and C. Ferreyra. “Novel lateral flow assay for point-of-care detection of Neisseria gonorrhoeae infection in syndromic management settings: A cross-sectional performance evaluation”. Lancet, vol. 403, no. 10427, pp. 657-664, 2024.
B. Van Der Pol, S. N. Taylor, L. Mena, J. Lebed, J. McNeil, L. Crane, A. Ermel, A. Sukhija-Cohen and C. A. Gaydos. “Evaluation of the Performance of a point-of-care test for Chlamydia and Gonorrhea”. JAMA Netw Open, vol. 3, no. 5, p. e204819, 2020.
C. A. Gaydos, J. D. Klausner, N. P. Pai, H. Kelly, C. Coltart and R. W. Peeling. Rapid and point-of-care tests for the diagnosis of Trichomonas vaginalis in women and men”. Sexually Transmitted Infection, vol. 93, no. S4, pp. S31-S35, 2017.
A. L. McRee, A. Esber and P. L. Reiter. “Acceptability of home-based chlamydia and gonorrhea testing among a national sample of sexual minority young adults.” Perspectives on Sexual and Reproductive Health, vol. 47, no. 1, pp. 3-10, 2015.
R. L. Cook, L. Østergaard, S. L. Hillier, P. J. Murray, C. C. Chang, D. M. Comer, R. B. Ness and DAISY Study Team. “Home screening for sexually transmitted diseases in high-risk young women: Randomised controlled trial”. Sexually transmitted infection, vol. 83, no. 4, pp. 286-291, 2007.
H. E. Jones, S. A. Lippman, H. H. Caiaffa-Filho, T. Young and J. H. Van De Wijgert, “Performance of a rapid self-test for detection of Trichomonas vaginalis in south Africa and Brazil”. Journal of Clinical Microbiology, vol. 51, no. 3, pp. 1037-1039, 2013.
K. Martin, R. Wenlock, T. Roper, C. Butler and J. H. Vera. “Facilitators and barriers to point-of-care testing for sexually transmitted infections in low-and middle-income countries: A scoping review”. BMC Infectious Diseases, vol. 22, no. 1, p. 561, 2022.
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