HPV molecular detection from urine versus cervical samples: an alternative for HPV screening in indigenous populations

Abstract

Background Cervical cancer (CC) is the fourth leading cause of death from neoplasms in women and is caused by the human papilloma virus (HPV). Several methods have been developed for the screening of cervical lesions and HPV; however, some socio-cultural factors prevent women from undergoing gynecological inspection, which results in a higher risk of mortality from cervical cancer in certain population groups as indigenous communities. This study aimed to compare the concordance in HPV detection from urine and cervical samples, to propose an alternative to cervical scraping, which is commonly used in the cervical cancer screening. Methodology The DNA from cervical scrapings and urine samples was extracted using the proteinase K method followed by precipitation with alcohol, phenol andchloroform; a modification of the proteinase K method was developed in the management of urine sediment. Viral genotyping was performed using INNOLipa. Results The study population consisted of 108 patients from an indigenous population at southern Mexico, 32 without squamous intraepithelial lesions (NSIL) and 76 with low squamous intraepithelial lesions (LSIL). The majority of NSIL cervical scrapes were negative for HPV (90.63%), whereas more than half of LSIL cases were high-risk HPV positive (51.32%), followed by multiple infection by HR-HPV (17.11%), and multiple infection by LR- and HR-HPV (9.21%). No statistically significant relationship between the cytological diagnosis and the HPV genotypes detected in the urine samples was observed. A concordance of 68.27% for HPV positivity from urine and cervical samples was observed. Similarly, a concordance of 64.52% was observed in the grouping of HPVs by oncogenic risk. HR-HPV was detected in 71% of the urine samples from women with LSIL diagnosis, which suggests that HR-HPV detected in a urine sample could indicate the presence or risk of developing SIL. Conclusion HR-HPV detection in urine samples could be an initial approach for women at risk of developing LSIL and who, for cultural reasons, refuse to undergo a gynecological inspection.

Comparison of Urine and Genital Samples for Detecting Human Papillomavirus (HPV) in Clinical Patients

“…As expected, we found a higher concordance rate between urine and genital samples for HPV16 and any of other HR-genotype detection than for low oncogenic risk HPV genotype, especially in males. This result was consistent with other published studies [ 8 , 12 , 15 , 20 , 24 ]. It has been reported that high-risk HPV infection may cause more exfoliated cervical cells in urine, and reflected a higher grade of cervical lesions compared with those low oncogenic risk HPV.…”

Comparison of Human Papillomavirus Genotype Detection in Paired Urine and Self-Collected Cervical Swabs: A Pilot Study

“…Urinary HPV testing is performed on the basis that urine can be used for the detection of HPV as the epithelial wall of the uterine cervix and/or vagina normally sheds exfoliated cells into the urine and if there is HPV or any other microbial infections, the shredded cells should contain viral genomes virions including genomes of other infectious organisms. Therefore first void urine sampling has been utilized for the detection of HPV by several authors (Bober et al, 2021;Leeman et al, 2017;Torres-Rojas et al, 2021;Vorsters, Van Damme, et al, 2014). A study Nilyanimit et al, (2017) suggests that urine represents a viable substitute for cervical swabs in detecting HPV.…”

Advanced technologies towards improved HPV diagnostics

“…On the other hand, urine testing faces challenges such as lower HPV load, presence of PCR inhibitors and contaminating pathogens, and possible higher rate of false positives due to HPV infection of the urinary tract or the lower genital tract. Although many studies have shown correlation between HPV detection in cervix and urine, 195,197–203 they were often very discrepant due to diverse methodologies used during sampling, storage, sample preparation, and DNA extraction, and further optimization and standardization is required.…”

“…On the other hand, urine testing faces challenges such as lower HPV load, presence of PCR inhibitors and contaminating pathogens, and possible higher rate of false positives due to HPV infection of the urinary tract or the lower genital tract. Although many studies have shown correlation between HPV detection in cervix and urine,195,[197][198][199][200][201][202][203] they were often very discrepant due to diverse methodologies used during sampling, storage, sample preparation, and DNA extraction, and further optimization and standardization is required. Regarding the blood analysis, most authors focus on the role of HPV circulating DNA as a prognostic biomarker in blood of patients F I G U R E 3 Schematic illustration of the photoelectrochemical biosensor array (PEBA) platform.…”