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Urine check for HPV recommended as alternative to smear test

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A urine test that detects the human papilloma virus could offer women a less invasive alternative to a cervical test, experts have said.

Offering a less time-consuming alternative could also increase screening uptake, they said.

The virus is one of the commonest sexually transmitted infections – up to 80% of sexually active women are infected at some point in their lives. While many strains of HPV are harmless, others can disrupt the normal functioning of cells and trigger cervical cancer.

Researchers said there has been a downward trend in uptake of the smear test and suggested this was because of the invasive nature of the examination and the time it takes.

They said the detection of HPV in the cervix is being tested as a new method for cervical cancer screening.

“A test with these qualities could considerably increase uptake”

Study authors

But some tests for the virus share the same problems as a smear test and might not improve screening uptake rates, according to the researchers from Barts and The London School of Medicine and Dentistry.

So they decided to investigate the effectiveness of urine tests for the virus. The authors analysed data from 14 studies which held the data of 1,443 women

The study, published in The British Medical Journal, found that the tests that identified presence of HPV were 87% accurate, and 94% of tests that gave negative results gave the correct result.

Two strains of the virus, HPV 16 and HPV 18, have been found to cause around 70% of cervical cancer cases. And urine tests correctly identified 98% of negative tests and 73% of positive tests, the researchers found.

They concluded that urine tests have “good accuracy” for detection of HPV.

Urine test for HPV recommendedUrine test recommended for HPV

“The detection of HPV in urine is non-invasive, easily accessible, and acceptable to women, and a test with these qualities could considerably increase uptake,” they wrote.

In an accompanying editorial in the journal, researchers at the University of Manchester said self-controlled HPV testing – involving a urine test or a vaginal swab – could provide a “a feasible alternative to HPV testing of cervical samples collected by health professionals”.

They added: “In well-resourced health systems, self-sampling could be used for women who are reluctant to attend for regular cervical screening.

“In lower income countries that lack infrastructure, self-sampling might even be beneficial and cost effective for all women who are eligible for screening.

“More research is now required to identify the true clinical performance and acceptability of urine testing for HPV in both settings.”

In England and Northern Ireland, women between the ages of 25 and 64 are invited for cervical screening, with those aged 25 to 49 screened every three years and those aged 50 to 64 screened every five years.

In Scotland, screening is routinely offered every three years to women aged between 20 and 60. This will be extended to the age of 64 from 2015.

In Wales, women between 20 and 64 are screened every three years.

 

 

 

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Readers' comments (2)

  • All smear test conducted on me have been awful.I could not list all of the issues, but none have been comfortably performed.Discomfort includes: feeling as though my skin is being pinched and my outsides being dragged inside. All have involved a deep pinching sensation.The worst had me raising myself upwards to avoid the pain which was like having a blunt knife stuck into the recess at the side of the cervix and having it dragged across the cervix, including prodding. When my leg gave way I basically fell onto a blunted knife which was still in the recess to the side of cervix. Another, less painful to start with, was like having a spade dig into the base of the cervix. Another lasted 45 mins, and in the end I ask to insert the speculum.

    I ordered a speculum from Medisave, inserted it into my own vagina, had a mirror between my toes and a torch in my mouth and I could see my cervix. My conclusions were that they needed to use a longer speculum (I was not a nurse). Prior to conducting the smear test, a woman should be examined to both locate the cervix and estimate the best size speculum.

    A longer speculum, reaching to the top of the vagina will prevent the skin being trapped in the corners of the spec. (I was told the sensitivity was due to taking the pill, although I was never asked where the pain was, although it was from being pinched). Even with a longer spec., my cervix is so tilted that it would need some effort. By using a shorter (standard) spec, when opened, it is like opening something widely only half-way up some tubing . When the spec is then shoved and pushed, it just scrapes the sides of the vagina.

    I have complained to the NMC (no trust mentioned) and emailed the editor here. I am not hopeful that basic practice will improve, but just to say that shoes come in more than one size, and so do specs. Why then the routine practice of avoiding appropriate selection? Most nurses do not wish to cause pain, so why is training so poor for them that they select a standard size? As far as defensible documentation, there is nothing on those notes that truthfully details my experience, otherwise a nurse would be criticising her own behaviour. Nor is there anything noted that would help the next nurse in her attempt (i go to a clinic, not my own surgery). To date, I am the only person who has been able to insert a speculum without hurting me at the cervix or vagina, and who can actually see the cervix. Sexual Health clinics often have nurses who are v. close to/passed normal retirement age.These clinics must not be used as easy money (drop-in clinic, barely anyone there when I go). I used this clinic because I thought people would be more knowledgeable than at the surgery, but due to my experiences, I am now afraid to visit my surgery, with people I know, and who are pushed for time (not a drop-in session). In talking to people and looking online, most people do not get examined first, and those who have a tilted uterus tend to have to put up with the discomfort. Asking where the pain is would have helped. I had explained the problem to the nurse and she said she would do her best.Being nice means you are less likely to plow ahead and project your stress onto the patient, but if there is no change of method, then it makes minimal difference. If there is no formal change of practice standards, then performance and experience is hit & miss.

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  • My last test was so painful that it had to be abandoned - one nurse tried three times, I went back the next week and the same thing happened with a different nurse, and my GP has now prescribed a course of pessaries to try and make things more comfortable so that I can have the examination. Personally I believe they will make no difference. Anything that will make this procedure less unpleasanr for post-menopausal women will be wlcome.

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