Monitoring human papillomavirus prevalence in urine samples: a review

Abstract

Human papillomavirus (HPV) is the main cause of cervical cancer, and many countries now offer vaccination against HPV to girls by way of government-funded national immunization programs. Monitoring HPV prevalence in adolescents could offer a near-term biological measure of vaccine impact, and urine sampling may be an attractive large-scale method that could be used for this purpose. Our objective was to provide an overview of the literature on HPV DNA detection in urine samples, with an emphasis on adolescents. We searched the PubMed database using the terms “HPV” and “urine” and identified 21 female and 14 male study populations in which HPV prevalence in urine samples was reported, four of which included only asymptomatic female adolescents. We provide herein an overview of the recruitment setting, age, urine sampling procedure, lesion type, HPV assay, and HPV prevalence in urine samples and other urogenital samples for the studies included in this review. In female study populations, concordance for any HPV type and type-specific concordance in paired urine and cervical samples are provided in addition to sensitivity and specificity. We concluded that few studies on HPV prevalence in urine samples have been performed in asymptomatic female adolescent populations but that urine samples may be a useful alternative to cervical samples to monitor changes in HPV prevalence in females in the post-HPV vaccination era. However, care should be taken when extrapolating HPV findings from urine samples to the cervix. In males, urine samples do not seem to be optimal for monitoring HPV prevalence due to a low human genomic DNA content and HPV DNA detection rate compared to other urogenital sites. In each situation the costs and benefits of HPV DNA detection in urine compared to alternative monitoring options should be carefully considered.

Comparison between Urine and Cervical Samples for HPV DNA Detection and Typing in Young Women in Colombia

“…Similarly, urine sampling has been proposed as an adequate alternative for monitoring HPV prevalence in female adolescents in order to determinate the early effect of HPV vaccination in the targeted age cohorts (19,(30)(31)(32)(33). However, the results have not been conclusive due to a number of variables that could negatively affect HPV detection.…”

“…In this context, the Colombian government is designing a surveillance system, and the screening based on DNA testing for HPV types could offer the opportunity to measure the impact of a vaccination program in an early stage. Nevertheless, an efficient and feasible method for detecting and genotyping HPV with high analytical sensitivity is necessary (19,20).…”

“…The use of a noninvasive and easy self-collection sampling method, like a urine sample to detect HPV DNA, could offer a more accessible and acceptable method to simplify HPV vaccine monitoring (19,20). This approach could allow sampling of large cohorts to measure the impact of HPV vaccination programs in sentinel municipalities or within cohort studies (20,21).…”

Detection of Genital HPV Infection Using Urine Samples: a Population Based Study in India

“…Urine is an adequate alternative specimen to monitor HPV prevalence among women when there are cultural and religious hardships in obtaining genital samples (Vorsters et al, 2012) (Enerly et al, 2013) (Mendez et al, 2014). Eventhough urine samples are less sensitive compared to cervical samples, it is inexpensive and more socially acceptable for large epidemiological surveys in developing countries.…”

Infecciones de transmisión sexual silentes: la muestra de orina permite una adecuada detección

“…Lamentablemente, la cantidad de ADN viral obtenido de estas muestras es bajo. A pesar de esta gran desventaja, el uso de las nuevas TAAN como la detección de VPH mediante RPC en tiempo real hace posible detectar la infección aun cuando se dispone de bajas cantidades de ADN 59 . La orina es una muestra no invasora y de fácil obtención lo que ha fomentado su uso, ya que esta produce un menor rechazo por parte de los pacientes en comparación al uso de exudados, los que deben ser recolectados mediante métodos invasores, produciendo incomodidad.…”