title: Comparison of lavage and swabs for the collection of genital ulcer specimens to measure HIV RNA shedding.
abstract: BACKGROUND
  The optimum collection procedure for the evaluation of HIV-1 burden in ulcer secretions has not been well defined.
  
  
  OBJECTIVE
  The objective of this study was to compare ulcer swabs and ulcer lavages for the detection and quantitation of HIV-1 RNA in genital ulcers.
  
  
  METHODS
  A convenience sample of the first 84 HIV-positive participants in a randomized double blind placebo controlled trial of acyclovir episodic treatment among men with genital ulcer disease were included in this evaluation. At baseline, participants were screened for HIV, syphilis and HSV-2 by serology and for ulcer etiology by PCR. Ulcer specimens were collected by using (1) a non-traumatic washing procedure with 10ml of PBS, and (2) sterile dry swabs. Ulcer samples were tested with HIV-1 Amplicor 1.5 Ultra Sensitive Assay with a lower threshold of 50 copies/ml.
  
  
  RESULTS
  Of ulcer samples 35 (41.7%) had HIV detected by ulcer lavage and 32 (38.1%) by swabs (p=0.68). Overall, 45 (53.6%) were positive by one or both methods. The overall proportion of agreement was 73% (61/84). The chance-corrected proportion of agreement was 0.46 (95% CI: 0.26, 0.65) as estimated by the Kappa statistic. The log mean viral load from lavages (1.49log(10) copies/ml, 95% CI: 1.17-1.81) did not differ significantly from that of swabs (1.41log(10) copies/ml, 95% CI: 1.16-1.71) (p=0.29) with a mean difference of 0.08log copies/ml (SD 0.96).
  
  
  CONCLUSIONS
  Ulcer lavage and ulcer swab performed in moderate agreement in the detection and quantitation of HIV RNA from ulcer specimens.
authors.affiliation: National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA. gpaz@gt.cdc.gov
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
authors.forename: Maya
authors.initials: M
authors.lastname: Sternberg
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.forename: Ewaldé
authors.initials: E
authors.lastname: Cutler
authors.forename: Mariza
authors.initials: M
authors.lastname: Vos
authors.forename: Ron
authors.initials: R
authors.lastname: Ballard
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
mesh_terms: D000328:Adult; D000465:Algorithms; D005832:Genital Diseases, Male / Q000821:virology*; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D007507:Therapeutic Irrigation; D014456:Ulcer / Q000821:virology*; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral