Participant acceptability questionnaire results from the Meatal swab Yourself with Testing for Infections Collectively (MYSTIC) study: a diagnostic accuracy study of rectal and pharyngeal swabs pooled with meatal swabs, or first-catch urine, for gonorrhoea and chlamydia detection

Objective To assess the views of men who have sex with men (MSM) and transgender women (TGW) on acceptability of using meatal swabs compared with first-catch urine (FCU), and acceptability and accuracy of pooling three-site samples compared with individually analysed samples, for gonorrhoea and chlamydia detection, using a questionnaire. Methods Prospective, convenience, sample of MSM/TGW attending UK sexual health clinic. Randomised order of self-taken samples from the pharynx and rectum, plus self-taken penile-meatal swab and FCU, for gonorrhoea and chlamydia detection. Participants were then asked to complete a questionnaire on acceptability and ease of taking the meatal swabs compared with FCU samples, and the pooling processes compared with individual samples. Results Questionnaire completion was 426/432 (98.6%) of participants offered it. Over 90% reported: finding written instructions and diagrams about taking the meatal swab clear and easy to follow; feeling confident about taking the meatal swab; finding written instructions and diagrams of how to pool the samples clear and easy to follow; and being confident about pooling the samples. When asked ‘If the pooled sample with the meatal swab was the same at finding chlamydia as the pooled sample with the urine’ 50% would prefer the meatal swab, 42% preferred urine and 8% had no preference. When asked ‘If the pooled sample with the meatal swab was better at finding chlamydia than the pooled sample with the urine’ 86% would prefer the meatal swab, 12% preferred urine and 2% had no preference. Conclusions In this first study to assess people’s views of taking their own penile-meatal swab versus FCU, the MSM/TGW participants found taking meatal swabs was easy and acceptable and a small majority preferred them to FCU even if no improved diagnostic sensitivity over urine. These results challenge the conventional thinking that urine is the preferred urogenital sample in MSM/TGW.