title: Accuracy of urinary human papillomavirus testing for presence of cervical HPV: systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the accuracy of testing for human papillomavirus (HPV) DNA in urine in detecting cervical HPV in sexually active women.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Searches of electronic databases from inception until December 2013, checks of reference lists, manual searches of recent issues of relevant journals, and contact with experts.
  
  
  METHODS
  Test accuracy studies in sexually active women that compared detection of urine HPV DNA with detection of cervical HPV DNA.
  
  
  METHODS
  Data relating to patient characteristics, study context, risk of bias, and test accuracy. 2 × 2 tables were constructed and synthesised by bivariate mixed effects meta-analysis.
  
  
  RESULTS
  16 articles reporting on 14 studies (1443 women) were eligible for meta-analysis. Most used commercial polymerase chain reaction methods on first void urine samples. Urine detection of any HPV had a pooled sensitivity of 87% (95% confidence interval 78% to 92%) and specificity of 94% (95% confidence interval 82% to 98%). Urine detection of high risk HPV had a pooled sensitivity of 77% (68% to 84%) and specificity of 88% (58% to 97%). Urine detection of HPV 16 and 18 had a pooled sensitivity of 73% (56% to 86%) and specificity of 98% (91% to 100%). Metaregression revealed an increase in sensitivity when urine samples were collected as first void compared with random or midstream (P=0.004).
  
  
  CONCLUSIONS
  The major limitations of this review are the lack of a strictly uniform method for the detection of HPV in urine and the variation in accuracy between individual studies.
  
  
  CONCLUSIONS
  Testing urine for HPV seems to have good accuracy for the detection of cervical HPV, and testing first void urine samples is more accurate than random or midstream sampling. When cervical HPV detection is considered difficult in particular subgroups, urine testing should be regarded as an acceptable alternative.
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and dentistry, London E1 2AB, UK.
authors.forename: Neha
authors.initials: N
authors.lastname: Pathak
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and dentistry, London E1 2AB, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Dodds
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and dentistry, London E1 2AB, UK Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiologia y Salud Publica, Madrid, Spain javier.zamora@hrc.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.affiliation: Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and dentistry, London E1 2AB, UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khan
mesh_terms: D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D002584:Cervix Uteri / Q000821:virology*; D004279:DNA, Viral / Q000652:urine*; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000821:virology*; D012680:Sensitivity and Specificity; D016482:Urinalysis; D059349:Urine Specimen Collection / Q000379:methods
chemical_list: D004279:DNA, Viral