Episode 232 -- June 2025 -- Part 2 AFP: American Family Physician

Summary

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AFP Podcast Episode 232 — June 2025, Part 2

Date: June 30, 2025
Host: Steve Brown (with Marian Dawson, Nadia Mohamed, et al.)
Source: University of Arizona College of Medicine–Phoenix Family Medicine Residency

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Episode Overview

This action-packed episode covers a range of high-yield topics from the June 2025 issue of American Family Physician, focusing on practical, evidence-based clinical pearls. Topics include nocturia evaluation and management, risk assessment tools for atrial fibrillation, fracture prevention with zolendronate, the diagnosis and management of endometrial cancer, diabetes-related foot infections, and a new at-home STI testing kit for gonorrhea and chlamydia. The hosts weave in humor, quick mnemonics, and actionable tips for primary care.

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Key Discussion Points & Insights

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1. Nocturia: Evaluation and Management

Timestamps: [01:29] – [05:05]

• Definition & Importance:
  • Nocturia is clinically significant when patients wake two or more times per night.
    — Nadia Mohamed [01:37]: “Nocturia has been associated with decreased quality of life, increased risk of depression, cognitive impairment, and mortality due to the sleep disruption.”
• Risk Factors & Etiology:
  • Medications (diuretics), age, diabetes, heart failure, sleep apnea.
  • Four mechanisms: overnight urine production ↑, storage capacity ↓, incomplete emptying, or sleep disorder.
• Diagnostic Tools & Approach:
  • Use the TANGO questionnaire to assess etiology.
  • Urinalysis to rule out UTI, hematuria, glucosuria, proteinuria.
  • Recommend bladder diary and frequency/volume charts.
• Management:
  • Conservative: Timing of diuretics, limiting fluids (esp. 2-3 hours pre-bed), manage comorbidities, restrict caffeine/alcohol, compression stockings, leg elevation, pelvic floor PT.
  • Pharmacotherapy:
    • Check post-void residual before meds.
    • Desmopressin for overactive bladder (be cautious of hyponatremia, esp. in those >65; lower doses for women.)
    • Anticholinergics/antimuscarinics/beta-adrenergics—use with care in older adults.
    • Topical estrogen for postmenopausal women.
  • Referral: Urology/urogynecology for persistent cases.
• Memorable Mnemonic:
  • Marian Dawson’s “888 Rule” [05:04]: “Eight hours of sleep, eight hours of fluids, and then hold for eight hours to improve your nocturia.”

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2. Assessing Risk of Developing Atrial Fibrillation

Timestamps: [05:05] – [07:20]

• Three Tools Reviewed:
  1. CHARGE-AF
     • 13 predictors incl. EKG; validated but only fair accuracy.
  2. Framingham HSAF
     • Seven predictors, easier in clinic, needs EKG; slightly better than CHARGE-AF.
  3. HARMS2AF
     • Seven risk factors, no EKG needed, largest dataset (300,000+), best accuracy and generalizability.
     • Categorizes risk from <1% to 18%.
• Bottom Line:
  — Nadia Mohamed [07:06]: “If you needed a quick point of care tool... the HARMS2AF risk score is the most convenient and the most accurate tool to use.”

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3. Zolendronate for Fracture Prevention in Women

Timestamps: [07:20] – [09:47]

• Clinical Question: Does zolendronate, given once or twice over 10 years in women 50–60 with T-score 0 to -2.5, reduce fracture risk?
• Study Findings:
  • Vertebral fractures: 6% (zolendronate) vs 11% (placebo), NNT = 21–22.
  • Any fracture: NNT = 13 (zolendronate once), NNT = 9 (twice).
  • Major osteoporotic fractures: NNT = 14.
  • Single infusion yields most benefits over 10 years.
  • No cases of jaw osteonecrosis or atypical femoral fractures.
• Quote:
  — Steve Brown [09:30]: “That is a pretty good case for fire and forget. For fracture prevention, you get almost all the fracture prevention from a single infusion of zolendronate... between the ages of 50 and 60.” — Nadia Mohamed [09:43]: “That is really remarkable.”

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4. Endometrial Cancer — Rapid Evidence Review

Timestamps: [10:14] – [13:54]

• Epidemiology: More common in postmenopausal women, but can occur at any age.
• Risk: 1 in 11 with postmenopausal bleeding harbor cancer; 85% of cancers present with abnormal uterine bleeding.
• Risk Factors: Unopposed estrogen, Lynch syndrome, obesity, tamoxifen, nulliparity, estrogen-producing tumors.
• Diagnosis:
  • First-line: Endometrial biopsy or pelvic ultrasound (best: transvaginal + transabdominal w/ Doppler).
  • Transvaginal stripe <4mm in postmenopausal women = very low cancer risk.
  • Biopsy is highly accurate but can miss patchy disease (<50% lining).
  • If suspicion stays high, next step is D&C (more tissue; higher risk/cost).
  • Focal US lesions → hysteroscopy for targeted biopsy.
• Staging & Treatment:
  • Sentinel lymph node biopsy for staging.
  • Stage 1: TAH-BSO if low grade; ovaries may be spared if fertility desired.
  • Stage 2: Includes cervical stroma; add radiation/clinical trials.
  • Stages 3/4: Local or distant spread — surgery, chemo, immunotherapy, radiation as indicated.
  • 5-year survival: Stage 1 (95%), Stage 3 (70%), Stage 4 (19%).
• Disparities:
  • Overall survival: White women 83%, Black women 62%.
• Summary:
  — Marian Dawson [13:54]: “Endometrial cancer is very treatable if caught early.”

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5. Diabetes-Related Foot Infections — Guideline Highlights

Timestamps: [13:58] – [15:53]

• Guideline Score: 7/8 (lacks broad developmental group).
• Key Recommendations:
  • Use foot ulcer classification (see Table 1 in article).
  • For soft tissue infection, culture tissue preferred over wound swab.
  • For osteomyelitis diagnosis: Combine probe-to-bone test, plain X-rays, inflammatory markers (ESR, CRP, procalcitonin). MRI if uncertain.
  • Probe-to-bone: Sensitivity 87%, specificity 83%.
  • Consider bone biopsy if osteomyelitis suspected.
  • Half of diabetic foot ulcers are NOT infected — avoid overuse of antibiotics.
  • Use narrow antibiotics for mild, broad for complicated/severe.
  • Urgent surgery for severe infection (gangrene, abscess, etc).
• Pearl:
  — Marian Dawson [15:41]: “Urgent surgical consultation is recommended for moderate or severe infection with extensive gangrene, deep abscess or other worrying some findings.”

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6. At-home Gonorrhea & Chlamydia Testing: The Simple 2 Test

Timestamps: [15:53] – [18:14]

• What is it?
  • FDA-approved at-home nucleic acid amplification test (NAAT) for adults 18+; not for known exposures.
• Advantages:
  • Privacy, autonomy, convenience; reduces stigma; increases testing reach.
• Accuracy:
  • Chlamydia: Sens ≥94%, Spec ≥97%.
  • Gonorrhea: Sens ≥91%, Spec ≥97%.
  • High positive likelihood ratios (>30), low negative (<0.1).
• Sample:
  • Vaginal swab (higher sensitivity) for those with vaginas, urine for those with penises.
• Logistics:
  • Results online in 2–5 days.
  • Positive gonorrhea results: requires in-person office visit for treatment.
  • Chlamydia treatment may be arranged by manufacturer.
  • Cost: $99 per test (not included in insurance; may be a barrier).
  • WHO now recommends self-collected STI testing to increase access.
• Quotes: — Steve Brown [17:45]: “Wow.” — Marian Dawson [17:49]: “Cost can be a barrier... $99 for a single test.” — Steve Brown [17:54]: “Bottom line here is that the Simple 2 home test can be a useful test for interested patients.”

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Memorable Quotes & Moments

• Nocturia: “The 888 Rule” mnemonic
  Marian Dawson [05:04]: “Eight hours of sleep, eight hours of fluids, and then hold for eight hours to improve your nocturia.”
• Fracture Prevention: “Fire and Forget”
  Steve Brown [09:30]: “That is a pretty good case for fire and forget. For fracture prevention, you get almost all the fracture prevention from a single infusion of zolendronate... between the ages of 50 and 60.”
• Risk Tool Choice:
  Nadia Mohamed [07:06]: “HARMS2AF risk score is the most convenient and the most accurate tool to use.”
• On disparities in endometrial cancer:
  Nadia Mohamed [13:26]: “...the overall survival rate for endometrial cancer is 83% in white women and 62% in Black women, which is one of the largest disparities in all cancers.”
• At-home STI testing reality check:
  Marian Dawson [17:47]: “It is not [included in the price].” Nadia Mohamed [17:48]: “Absolutely not.”

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Suggested Timestamps for Key Segments

| Topic | Start – End Timestamps | |--------------------------------------------------------|------------------------| | Nocturia: Evaluation & Management | [01:29] – [05:05] | | Atrial Fibrillation: Risk Assessment Tools | [05:05] – [07:20] | | Zolendronate for Fracture Prevention | [07:20] – [09:47] | | Endometrial Cancer: Rapid Review | [10:14] – [13:54] | | Diabetes-Related Foot Infections: Guideline Highlights | [13:58] – [15:53] | | At-home Gonorrhea/Chlamydia Testing (Simple 2) | [15:53] – [18:14] |

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Takeaways

• Always start nocturia workups with a solid history and conservative management.
• Use the HARMS2AF score (no EKG needed) for quick, accurate AFib risk estimation.
• A single zolendronate infusion can significantly reduce future fracture risk in women 50–60 with normal/osteopenic bone density.
• Early evaluation and prompt biopsy are crucial in abnormal uterine bleeding and endometrial cancer prevention.
• For diabetic foot infections, focus on clinical findings + targeted diagnostics, with judicious antibiotic use.
• New options like at-home STI testing can improve access, but costs and follow-up logistics remain important.

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For more clinical pearls and details, see the full June 2025 issue of American Family Physician or visit aafp.org.

Transcript

[Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AAFP in partnership with the cdc with a free report to help physicians guide patients toward informed immunization decisions using proven quality improvement strategies. Access the [e-mail] vaccines welcome to the.

[Steve Brown]

American Family Physician podcast for part two of the June 2025 issue. I'm Steve.

[Marian Dawson]

I'm Marian.

[Nadia Mohamed]

I'm Nadia.

[Steve Brown]

We are residents and faculty, mostly residents from the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we're going to talk about nocturia, assessing risk of developing atrial fibrillation, zolendronate to reduce fracture risk, endometrial cancer, diabetes related foot infections, and an at home test for gonorrhea and chlamydia.

[Hailey Hochstein]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians. The editor of American Family Physician or Banner Health. Do not use this podcast for medical advice. Instead, see your own family doctor for medical care.

[Unknown Host/Announcer]

We're on a mission delivering the best from American family Position on a mission delivering the best from American family.

[Steve Brown]

Okay, we're going to start with nocturia evaluation and management. This is from doctors Gatane Sussman and Iglesia.

[Nadia Mohamed]

Nocturia is clinically significant when a patient wakes up two or more times per night.

[Steve Brown]

Why is nocturia important?

[Nadia Mohamed]

Nocturia has been associated with decreased quality of life, increased risk of depression, code cognitive impairment, and mortality due to the sleep disruption.

[Steve Brown]

So, Marian, what are the risk factors for nocturia?

[Marian Dawson]

Risk factors include medications such as diuretics, older age, diabetes, heart failure, and sleep apnea.

[Nadia Mohamed]

As always, an evaluation for nocturia starts with a good history and physical.

[Steve Brown]

So first you might think about the four mechanisms of nocturia. Increased nighttime urine production, decreased storage ability, incomplete bladder emptying, or primary sleep disorder.

[Marian Dawson]

I can't tell you the amount of patients who tell me when they wake up to pee that they drink a full cup of water before going back to bed.

[Steve Brown]

Don't do that.

[Marian Dawson]

So here's a useful tool. The validated questionnaire tango, targeting the individual's etiology of nocturia to guide outcomes.

[Nadia Mohamed]

Very clever, tango. It can help identify pertinent comorbidities in patients who have nocturrhea without concurrent lower urinary tract symptoms.

[Marian Dawson]

Perform a urinalysis to rule out a urinary tract infection, hematuria, glucosurria and proteinuria.

[Nadia Mohamed]

Also encourage patients to use a bladder diary including frequency volume charts.

[Steve Brown]

Okay, Nadia. So how do we help our patients who have bothersome nocturia?

[Nadia Mohamed]

We start with our handy dandy conservative management. Yes, this includes counseling patients on timing of diuretics, avoiding excessive daytime fluid intake, avoiding fluids two to three hours before bedtime, and addressing medical comorbidities.

[Marian Dawson]

Other conservative management strategies include limiting beverages such as caffeine and alcohol, wearing compression stockings, and elevating the legs for our patients with lower extremity edema. Pelvic floor physical therapy with biofeedback.

[Steve Brown]

Okay, so if things don't improve with conservative management, you might consider pharmacotherapy.

[Nadia Mohamed]

Complete bladder emptying should be evaluated with a a post void residual before starting medication.

[Marian Dawson]

For overactive bladder syndrome, desmopressin is a medication treatment option. Look out for contraindications, including hyponatremia, polydipsia, renal insufficiency, use of loop diuretics, and steroids.

[Steve Brown]

You're gonna have to order serum electrolytes several times before initiating the desmopressin, four to eight days after you start it, and then a month after you start it.

[Nadia Mohamed]

And?

[Steve Brown]

And patients older than 65 are at high risk for hyponatremia.

[Nadia Mohamed]

Interesting to note that women may need lower dosages compared to men.

[Steve Brown]

Yeah.

[Marian Dawson]

Anticholinergics, anti muscarinics, or beta adrenergic medications can be used in patients with overactive bladder syndrome.

[Steve Brown]

That was just a list of all the medications that are worse to give.

[Nadia Mohamed]

To older people quite over 65.

[Steve Brown]

Yeah, exactly. You might think about local estrogen therapy. This can help postmenopausal women with genital urinary syndrome symptoms.

[Nadia Mohamed]

Finally, referral to urology or urogynecology for advanced therapies is indicated if patient's symptoms do not improve with conservative management and pharmacotherapy.

[Marian Dawson]

When I was on my urology rotation attending, he always told me, for patients with nocturia, the 888 rule, eight hours of sleep, eight hours of fluids, and then hold for eight hours to improve your nocturia.

[Steve Brown]

Nice.

[Nadia Mohamed]

Eight.

[Steve Brown]

Eight sounds good. Next, we have a point of care guide assessing the risk of developing atrial fibrillation. This is from our deputy editor, Mark Abel.

[Marian Dawson]

All right, we're going to review three different tools today to assess a patient's risk of developing atrial fibrillation. Unfortunately, none of them are on mdcal, but they are easily Googleable.

[Nadia Mohamed]

All right, the cohorts for heart and aging research in genomic epidemiology for atrial fibrin fibrillation was used to make the Charge AF risk score. It looked at three US cohorts with over 18,000 patients from 60 to 73 years old and was validated in over 7,000 participants in two European cohorts with the average ages being in the mid-70s.

[Steve Brown]

This scoring tool uses 13 different predictors including EKG data. However, after the validation cohorts were completed, the studies only showed fair accuracy of this tool.

[Marian Dawson]

The Framingham Heart Study was used to create the FHSAF score. It was developed using just under 5,000 people with the mean age being around 61 years old.

[Nadia Mohamed]

In practice, this scoring system is easier to use because it only has seven predictors, but it does require an ekg. The validation of this tool was slightly better than the Charge AF risk score.

[Steve Brown]

Okay, no spoilers, but we may have saved the best for Last here. The harms2af risk score this tool was created for primary care physicians and uses seven different risk factors that do not require EKG data.

[Marian Dawson]

It used data from over 300,000 people with a mean age of 57 and was validated in over 7,000 patients. It was found to have generally good generalizability and very good accuracy. It categorizes patients into four risk groups with the lowest being a less than 1% risk of AFib and the highest being an 18% risk of developing AFib.

[Nadia Mohamed]

In summary, if you needed a quick point of care tool to assess a patient's risk for developing atrial fibrillation, the harms2af risk score is the most convenient and the most accurate tool to use.

[Steve Brown]

We have a poem Zolendinate Reduces fracture risk. This poem by Dr. Abel kind of makes me rethin fracture prevention. So poems are patient oriented evidence that matters. And the clinical question here is in women with normal bone density or osteopenia, does xolendronate brand name reclast given at baseline and 5 years later reduce the risk of fracture over 10 years?

[Marian Dawson]

This study recruited women ages 50 to 60 with a bone density T score between 0 and minus 2.5.

[Nadia Mohamed]

Remember, a value greater than negative one is considered normal.

[Steve Brown]

Over 1000 women were randomized to two zelendronate infusions 5 years apart, two placebo infusions or a single zolendronate infusion followed by a placebo infusion five years later.

[Nadia Mohamed]

Analysis was done by intention to treat at 10 years.

[Marian Dawson]

Vertebral fractures occurred in only about 6% of women in either zolendronate group and 11% in the placebo group for a number needed to treat of 21 to 22. Wow.

[Nadia Mohamed]

Not bad for any kind of fracture, the number needed to treat was 13 at 10 years for zalandronate 1 time.

[Steve Brown]

Versus placebo for any fracture the NNT was 9 at 10 years for 2 times xolendronate versus placebo.

[Marian Dawson]

Wow. For a major osteoporotic fracture, the number needed to treat comparing both zolendernate acid groups combined to placebo was only 14.

[Nadia Mohamed]

No cases of jaw osteonecrosis or atypical femoral fractures occurred in any group.

[Steve Brown]

We kind of nerded out on this one, so we went back to the original study in the New England Journal. They don't report number of hip fractures. Unfortunately, this would probably need a bigger study to show benefit for hip fractures alone. I would really like to see this.

[Marian Dawson]

Some people like to measure bone turnover markers and fracture prevention.

[Steve Brown]

I am not one of those people.

[Marian Dawson]

We know we staff with you for those people. You can see that the bone turnover remains below placebo for the entire 10 years with one dose of zelendronate.

[Steve Brown]

Wow. That is a pretty good case for fire and forget. For fracture prevention, you get almost all the fracture prevention from a single infusion of zolendronate Garden given between the ages of 50 and 60.

[Nadia Mohamed]

That is really remarkable.

[Steve Brown]

Yeah.

[Unknown Narrator]

We'll be right back.

[Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AAFP's upcoming Family Centered Pregnancy Care course happening August 25th through the 28th in Denver, Colorado. Arrive early for advanced life support obstetrics courses for providers and instructors. Register [e-mail] fcpc2025.

[Steve Brown]

Next endometrial cancer rapid evidence review from Drs. Bryce Gozda and first from our friends up the road from the Arizona Abrazzo Family Medicine Residency Program.

[Marian Dawson]

Wahoo.

[Steve Brown]

Yeah.

[Marian Dawson]

Endometrial cancer is more likely to affect postmenopausal women, but can happen in any age group. About one in 11 women with postmenopausal bleeding have endometrial cancer and 85% of women with endometrial cancer have abnormal uterine bleeding.

[Nadia Mohamed]

Risk factors include long term use of unopposed estrogen, lynch syndrome, obesity, tamoxifen use, nulliparity and estrogen producing tumors.

[Steve Brown]

You may incidentally pick up endometrial cancer on routine pap smear if your cytology comes back showing atypical glandular cells.

[Marian Dawson]

Speaking of diagnostic testing, the first line test can be endometrial biopsy or pelvic ultrasound. The best ultrasound to order is a combination transvaginal and transabdominal ultrasound with Doppler.

[Nadia Mohamed]

If the endometrial stripe is less than 4 millimeters in a postmenopausal woman, then it is extremely unlikely to be endometrial cancer in premenopausal women. Endometrial stripe thickness has no diagnostic value.

[Steve Brown]

Pipel endometrial biopsies have excellent diagnostic accuracy, but they can be prone to sampling error if the tissue sample is inadequate or if the disease encompasses less than 50% of the uterine lining.

[Marian Dawson]

If your endometrial biopsy is negative but your clinical suspicion remains high, the next step would be to complete a dilation and curettage to obtain a larger sample. However, this method is more expensive, painful and has increased risk of complications.

[Nadia Mohamed]

If you have a patient with a focal lesion on their ultrasound, a hysteroscopy for direct visualization and targeted biopsy is recommended.

[Steve Brown]

Okay, so we have the biopsy, we have the diagnosis. Let's talk about staging and treatment. Bilateral sentinel lymph node biopsies are critical for staging and can reduce the need for full pelvic lymphadenectomies. If low grade disease is found, it may not be necessary.

[Marian Dawson]

Stage 1 endometrial cancer is confined to the corpus uteri and the ovary in these women. If their histology shows low risk disease, they can be treated with a minimally invasive total abdominal hysterectomy and bilateral salving oophorectomies.

[Steve Brown]

If future fertility is desired, the ovaries may be spared depending on disease burden.

[Nadia Mohamed]

In stage two disease, the tumor invades into the cervical stroma but doesn't extend outside the uterus. These women receive the same surgery and may receive radiation or participate in clinical trials trials. The five year survival rate for localized disease is 95%.

[Steve Brown]

In stage three, there's a local invasion of the disease and five year survival is 70%. In stage four, the disease spreads to the bladder, intestinal mucosa or metastasizes and the five year survival rate is 19%.

[Marian Dawson]

Both stages three and four are treated with surgery if possible. Most patients also receive adjuvant chemotherapy and immunotherapy. Some will receive radiation, hormonal treatments or enroll in clinical trials.

[Nadia Mohamed]

In the United States, the overall survival rate for endometrial cancer is 83% in white women and 62% in black women, which is one of the largest disparities in all cancers.

[Steve Brown]

Okay, so to summarize, if you have a woman with abnormal uterine bleeding, start with an ultrasound or endometrial biopsy and move on from there. If your suspicion stays high but your tests are negative. A dilation and curettage may be appropriate.

[Marian Dawson]

Endometrial cancer is very treatable if caught early.

[Steve Brown]

Now a practice guideline, Diagnosis and Treatment of Diabetes Related Foot Infections from the International Working Group of the Diabetic Foot and the Infectious Disease Society of America, which we'll call the Guideline for short. No, we won't really do that, but Dr. Arnold, our fearless assistant medical editor, gives us us this summary.

[Nadia Mohamed]

AFP uses the GTRUS Guidelines Scorecard to tell us if this is a guideline we should trust.

[Marian Dawson]

This guideline gets a seven out of eight one point off for lacking a more broad developmental group.

[Steve Brown]

The guideline focuses on patient oriented outcomes, gives clear and actionable recommendations, grades the evidence by quality, and bases the recommendation on a systematic review. So here are a few key points from this guideline.

[Nadia Mohamed]

Use a foot ulcer classification as shown in Table 1 in the article.

[Marian Dawson]

If you think an infection is limited to the soft tissue, obtain a culture of the soft tissue sample as it's more accurate than a wound swab.

[Steve Brown]

To diagnose osteomyelitis, you can use a combination of probe to bone testing, plain radiography and esr, CRP or procalcitonin testing as initial tests.

[Nadia Mohamed]

Interestingly, the probe to bone test is 87% sensitive and 83% specific.

[Marian Dawson]

If you're still not sure if the patient has osteomyelitis after these tests, you can use an mri.

[Steve Brown]

If osteomyelitis is suspected, consider a bone biopsy on presentation.

[Nadia Mohamed]

1/2 of diabetic foot ulcers are actually not infected. Use antibiotics appropriately and cautiously. Consider narrow coverage for mild uncomplicated infections and broader coverage for moderate to severe infections.

[Marian Dawson]

Urgent surgical consultation is recommended for moderate or severe infection with extensive gangrene, deep abscess or other worrying some findings.

[Nadia Mohamed]

Overall, some helpful tips to keep in mind.

[Marian Dawson]

We got this all right.

[Steve Brown]

We're going to close things out with diagnostic tests. Simple 2 test for at home Gonorrhea and Chlamydia testing this is from Drs. Raymond and DePovloff from Maryland and Washington.

[Marian Dawson]

The Simple 2 test is an at home self collection test that is designed to detect gonorrhea and chlamydia. It is not intended for patients with a known exposure to gonorrhea or chlamydia.

[Nadia Mohamed]

Simple 2 is an FDA approved test that is indicated for use in non clinical settings for adults 18 and older.

[Steve Brown]

Some patients might prefer an in home test for more privacy, autonomy and convenience compared to in office testing.

[Marian Dawson]

In home testing can Reduce the fear of stigma often associated with clinic visits and help significantly increase the number of patients tested for STIs.

[Nadia Mohamed]

Okay, let's talk accuracy. This test uses a nucleic acid amplification test assay, which is highly accurate.

[Steve Brown]

For chlamydia, the sensitivity is greater than 94% and specificity is greater than 97%. It varies slightly by how the sample is obtained.

[Marian Dawson]

For gonorrhea, the sensitivity is greater than 91% and the specificity is greater than 97%.

[Steve Brown]

The positive likelihood ratios are incredibly high, all over 30 and the negative likelihood ratios are also quite favorable, all less than 0.1. Again, it depends on how the sample is obtained.

[Nadia Mohamed]

For patients with a vagina, vaginal swabs are recommended over urine samples due to better sensitivity.

[Marian Dawson]

For patients with a penis, urine samples are recommended.

[Steve Brown]

Remember, like any test, there can be false negative or false positive results.

[Nadia Mohamed]

So how do you get your results? Yeah, the results are reported online through the manufacturer portal and requires an in office visit. For treatment of gonorrhea, Chlamydia treatment is provided by the testing company.

[Steve Brown]

Wow.

[Marian Dawson]

Huh. I wonder if that's included in the price.

[Steve Brown]

It is not.

[Nadia Mohamed]

Absolutely not.

[Marian Dawson]

All right, well, the cost can be a barrier for some patients as it's $99 for a single test.

[Steve Brown]

Bottom line here is that the simple two home test can be a useful test for interested patients.

[Marian Dawson]

The world health organizations recommend self collection samples for gonorrhea and chlamydia to remove bare ears.

[Nadia Mohamed]

So you just gotta sample it, mail it in and the results are available online in two to five days. Your sample is received.

[Unknown Narrator]

That's a wrap on season 10. We've now released over 230 regular episodes and 18 bonus episodes in these 10 years of AFP podcast. Our podcast has been downloaded over 8 million times. Thanks for listening. We'll see you in season 11. Now, a special farewell and thank you to our season 10 hosts. Thanks to Dr. Seuss and oh, the places you'll go. Congratulations. Today is your day. You're off to great places. You're off and away. You have brains in your head. You have feet in your shoes. And you can steer yourself any direction you choose. You're on your own and you know what you know. And you are the doctor who'll decide where to go. What a year. Podcast season 10. So much knowledge. What a blast. It's been evidence, learning jokes and more fun. You're headed off. Your career has just begun and will you succeed? Yes, you will indeed. 98¾ percent guaranteed. Doc, you'll move mountains. So today is your day. Your mountain is waiting. So get on your way.

[Valeria Vazquez / Sierra Voy]

Hi, I'm Valeria Vazquez and I'm going to an FQHC in West Phoenix.

[Sydney Vowles]

Hi, I'm Sydney Vowles and I'm going to do primary care in Utah.

[Hailey Hochstein]

I'm Hailey Hochstein. I'm going to do academics faculty in Chandler.

[Nadia Mohamed]

I'm Nadia Mohamed and I'll be doing an FMOB fellowship in Phoenix.

[Valeria Vazquez / Sierra Voy]

I'm Sierra Voy and I'll be academic faculty and Chandler.

[Christopher Alvarez / Satyam Patel]

I'm Christopher Alvarez and I'll be doing a sports medicine fellowship at Emory University.

[Marian Dawson]

Howdy. I'm Marian Dawson and I'll be a PCP for Banner out in San Tan.

[Christopher Alvarez / Satyam Patel]

Hey, I'm Satyam Patel. I'll be doing a medical consultation for inpatient psychiatric facilities in Phoenix.

[Valeria Vazquez / Sierra Voy]

Please email us at [e-mail] or tweet fppodcast.

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[Marian Dawson]

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[Marian Dawson]

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[Sydney Vowles]

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We'll talk to you soon for the next edition of the American Family Physician Podcast.