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Urine test for HPV as sensitive as cervical smear testing, researchers find

Urine testing may have similar sensitivity in detecting HPV as cervical smear testing, a study has found, which may provide an alternative screening option for women who are anxious about cervical screening.

Researchers found that urine testing for the HPV virus was almost as sensitive as cervical testing for identifying women with CIN and suggested that urine testing could increase uptake and save GP time.

A study carried out by researchers in Manchester looked at just under 80 women attending a colposcopy clinic for management of abnormal cervical screening. The women were asked to self-collect a urine sample and a vaginal swab and also had a cervical sample collected by a practitioner.

The researchers found that the sensitivity of HPV testing from cervical and vaginal samples, or the proportion of positive results that were true positives, was 89%. In urine samples, the sensitivity of HPV testing was 83%. 

Acceptability questionnaires also found that the majority of women who provided a urine sample said that they preferred it to having a sample taken by a healthcare professional and would be happy to do it in the future.

The researchers noted that a preservative needs to be added to the urine samples for the best results, which would prevent samples from being taken at home and posted in for analysis. They did say, however that ‘it would not preclude self-collection within primary care, where preservative can be safely added shortly afterwards.’

The authors said in the paper: ‘Barriers to cervical screening include embarrassment, fear, inconvenience and the view held by some women that they are not at risk. Offering an alternative means of cervical screening can encourage non-attenders to be screened, either by ‘nudging’ them to undergo cervical sampling or by facilitating self-sampling at home. Urine-based testing is already widely used for the detection of chlamydia and is generally trusted and acceptable to women.’

‘Urine-based testing may also be cheaper than standard cervical screening tests because it does not require an appointment, a practitioner or any special equipment and it lends itself to high throughput testing. Thus it could also be suitable in resource poor settings where the infrastructure required to underpin screening by cervical cytology is lacking.’

The findings come as PHE launched a new campaign in March to tackle the 20-year low in cervical screening uptake.

Research published in April suggested that cervical screening rates have dropped in some areas due to ‘confusion’ over the roles that CCGs, local authorities and NHS England had to play in delivering screening following changes in the 2013 Health and Social Care Act.


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