What specimen is used to check Human Papillomavirus (HPV)?

From the Guidelines

Human papillomavirus (HPV) testing is typically performed using cervical specimens collected during a pelvic examination, with the most common specimen being a cervical swab or brush sample, which collects cells from the cervix, as recommended by recent guidelines 1. The specimen used for HPV testing can be obtained during a routine Pap smear procedure, where cells are collected from the cervical transformation zone—the area most susceptible to HPV infection and related cellular changes. Some key points to consider when collecting specimens for HPV testing include:

• The use of liquid-based cytology samples or direct HPV testing samples can facilitate the detection of high-risk HPV genotypes 1.
• Self-collected vaginal samples may also be used for HPV testing, though these are generally less sensitive than clinician-collected cervical samples 1.
• For males or for anal HPV testing, swabs from the penis, scrotum, or anal canal may be collected. HPV testing is important because persistent infection with high-risk HPV types is the primary cause of cervical cancer and is associated with other anogenital and oropharyngeal cancers, as highlighted in recent studies 1. The virus infects epithelial cells, potentially leading to cellular changes that can progress to cancer if left undetected. Current guidelines recommend the use of high-risk HPV testing for the triage of women aged ≥21 years who have abnormal Pap test results, as well as for routine adjunctive testing for women aged ≥30 years 1. It is essential to follow these guidelines to ensure effective screening and management of HPV-related diseases. The most recent guidelines from 2018 provide updated recommendations for the utilization of the microbiology laboratory for diagnosis of infectious diseases, including HPV testing 1. These guidelines emphasize the importance of using the correct specimen type and testing methodology to ensure accurate diagnosis and effective management of HPV-related diseases.

From the Research

Specimens Used for Human Papillomavirus (HPV) Testing

• The specimens used to check for Human Papillomavirus (HPV) include:
  • Cervical samples collected by physicians 2, 3, 4, 5
  • Self-collected vaginal samples 3, 4, 5
  • Urine samples 6, 3
  • Oral specimens, such as oral rinses or swabs 6
  • Blood samples, which can be used to detect cell-free DNA, including HPV DNA 6

Comparison of Specimens

• Studies have compared the effectiveness of HPV testing using different specimens, including:
  • Physician-collected cervical samples vs. self-collected vaginal samples 3, 4
  • Physician-collected cervical samples vs. urine samples 3
  • Self-collected vaginal samples vs. practitioner-collected cervical specimens 4
• The results of these studies have shown that:
  • HPV testing using self-collected vaginal samples and urine samples can be effective for cervical cancer screening 3, 4
  • The agreement rate between physician-collected and self-collected samples is high, particularly for high-risk HPV types 16 and 18 3, 4
  • Self-collection for HPV-based cervical screening shows good concordance and relative sensitivity when compared to practitioner-collected samples 4

Recommendations for Specimen Use

• The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee has developed recommendations for the use of self-collected vaginal specimens for HPV testing, including:
  • Clinician-collected cervical specimens are preferred, but self-collected vaginal specimens are acceptable for primary HPV screening of asymptomatic average-risk individuals 5
  • Repeat testing in 3 years is recommended following HPV-negative screens using self-collected vaginal specimens 5
  • Colposcopy with collection of cytology and biopsies is recommended following positive tests for HPV types 16 and 18 5