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Concordance of Self- and Clinician-Collected Anal Swabs to Detect Human Papillomavirus in a Sample of HIV-Negative Men

Yared, Nicholas F. MD1; Horvath, Keith J. PhD2; Baker, Jason V. MD1,3; Thyagarajan, Bharat MD, PhD4; Waterboer, Tim PhD5; Kulasingam, Shalini PhD2

Journal of Lower Genital Tract Disease: July 2019 - Volume 23 - Issue 3 - p 200–204
doi: 10.1097/LGT.0000000000000475
Original Research Article: Perianal and Anal

Objective The aim of this study was to determine the concordance of self- and clinician-collected anorectal swabs for the detection of human papillomavirus (HPV) DNA in a population of HIV-negative men who have sex with men (MSM).

Methods This cross-sectional study involved recruitment of HIV-negative MSM in a Midwestern US metropolitan area to collect paired sequential self- and clinician-collected anorectal swabs using illustrated instructions. Swabs were tested for type-specific HPV DNA with a comparison of type-specific HPV categories detected by each method. The sensitivity and specificity of self-collection were calculated assuming clinician collection as the criterion standard. McNemar's test and κ statistics were used to determine percent agreement and concordance of self- and clinician-collected swab results.

Results Seventy-eight participants had paired anorectal swab samples of adequate quality for analyses. The sensitivity and specificity of self-collected swabs for detection of all high-risk HPV DNA types were 69.8% and 91.4%, respectively. Similar degrees of sensitivity and specificity of self-collection were seen for other groups of high-risk HPV types. Percent agreement and κ statistic for self- and clinician-collected swabs for all high-risk HPV types were 80.8% and 0.53, respectively.

Conclusions Self-collected anorectal swab samples showed lower sensitivity but moderate to high specificity for detection of high-risk and vaccine-preventable HPV types compared with clinician-collected swab samples. Self-collection instructional details and the thoroughness of clinician collection of samples may have impacted sensitivity and specificity, suggesting a need to optimize and standardize instructions.

1Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN;

2Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN;

3Minnesota Medical Research Foundation, Minneapolis, MN;

4Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN; and

5Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

Reprint requests to: Nicholas Yared, MD, West Bank Office Bldg, University of Minnesota, 1300 South 2nd St, Suite 300 Minneapolis, MN 55454-1087. E-mail:

The authors have declared they have no conflicts of interest.

This study was supported by the University of Minnesota Masonic Cancer Center's Screening, Prevention, Etiology and Cancer Survivorship (SPECS) Program and the National Institutes of Health Infectious Disease Training in Clinical Investigation Grant (T32 AI055433-11A1).

This study received approval to be conducted by the University of Minnesota's Biomedical Institutional Review Board and the Institutional Review Board of the Minnesota Medical Research Foundation.

Online date: April 3, 2019

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology