A simple urine test for human papillomavirus (HPV) could offer a noninvasive alternative to the conventional cervical test and improve screening uptake, researchers from Queen Mary University of London have found. In a study published online in the British Journal of Medicine, the results of 14 studies involving 1,443 sexually active women to determine the accuracy of testing for HPV on urine samples compared with cervical samples obtained by a doctor. The quality of the studies was generally high.
Compared with cervical samples, urine HPV testing had an overall sensitivity of 87% (the proportion of positives correctly identified) and a specificity of 94% (the proportion of negatives correctly identified). Urine testing for “high risk” HPV types 16 and 18 (those that cause the majority of cervical cancer cases) had an overall sensitivity of 73% and a specificity of 98% compared with cervical samples.
Accuracy increased when “first-void” urine samples were collected (the first urine of the day) compared with random or mid-stream samples, probably because first void urine samples contain higher levels of DNA.
“The detection of HPV in urine is no-invasive, easily accessible, and acceptable to women, and a test with these qualities could considerably increase uptake,” say the authors. They stress that their results should be interpreted with caution “due to variation between individual studies” but say that when HPV testing is considered for cervical cancer screening, “urine-based testing should be considered as an accurate and acceptable alternative that could increase screening coverage.” They propose that testing urine for HPV “could accurately replace cervical testing for HPV in this context” and call for further studies and a “standardized method of urine HPV detection” to be developed.
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