title: Tampon samplings with longer cervicovaginal cell exposures are equivalent to two consecutive swabs for the detection of high-risk human papillomavirus.
abstract: BACKGROUND
  Self-sampling for human papillomavirus (HPV) is useful for triage of ASCUS Papanicolaou (Pap) smears. Tampons with 10-second cervicovaginal cell exposure can detect HPV but appear to be less efficient than two consecutive swabs.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate increased vaginal tampon exposures for detecting high-risk HPV.
  
  
  METHODS
  This longitudinal cohort study followed women who self-sampled weekly with tampons for progressively longer periods of time. A tampon was inserted for 10 seconds at the office visit and 1 hour, 4 hours, and overnight for the three subsequent home samples. Two concurrent swabs were used with each tampon sampling for contemporaneous comparisons. The MY09/MY11 PCR primer system with reverse line blot detection strips was used to detect 18 distinct high-risk HPV types.
  
  
  RESULTS
  Of the 309 tampons and 618 swabs used at home, 83% were returned. Among normal women, the 10-second tampon detected fewer with normal histology and high-risk HPV than did its swabs ( = 0.0412), but the 1-hour, 4-hour, and overnight tampons had high-risk-HPV detection rates equal to their swabs. In women with CIN, all tampons and swabs equally identified those with high-risk HPV.
  
  
  CONCLUSIONS
  Self-sampling for HPV detection is acceptable, feasible, and technically accurate for both tampons with longer cervicovaginal exposures and swabs. The choice of technique is dependent on the woman, her culture, and her clinician.
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth Medical School, Hanover, New Hampshire, USA. diane.harper@dartmouth.edu
authors.forename: Diane M
authors.initials: DM
authors.lastname: Harper
authors.forename: Meghan
authors.initials: M
authors.lastname: Raymond
authors.forename: Walter W
authors.initials: WW
authors.lastname: Noll
authors.forename: Dorothy R
authors.initials: DR
authors.lastname: Belloni
authors.forename: Laura Therrien
authors.initials: LT
authors.lastname: Duncan
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Cole
mesh_terms: D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016017:Odds Ratio; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013630:Tampons, Surgical / Q000382:microbiology*; D013997:Time Factors; D014412:Tumor Virus Infections / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology