Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients.
Open accessAbstract
BACKGROUND: High-risk human papillomavirus (hrHPV) causes virtually all cervical cancers. Trans masculine (TM) people (those assigned female at birth who identify with a gender other than female) have low uptake of conventional cervical cancer screening. Self-collected hrHPV DNA testing has high levels of acceptability among cisgender (non-transgender) females and may support increased cervical cancer screening uptake in TM individuals. OBJECTIVE: To assess the test performance and acceptability of self-collected vaginal specimens in comparison to provider-collected cervical swabs for hrHPV DNA detection in TM individuals ages 21-64 years. METHODS: Between March 2015-September 2016, 150 TM participants with a cervix (mean age = 27.5 years; SD = 5.7) completed a one-time study visit comprised of a self-report survey, self-collected vaginal HPV DNA swab, clinician-administered cervical HPV swab, and brief interview on acceptability of clinical procedures. Participants were randomized to complete either self- or provider-collection first to minimize ordering effects. Self- and provider-collected samples were tested for 13 hrHPV DNA types using a DNA Hybridization Assay. The primary outcome variable was the concordance (kappa statistic) and performance (sensitivity, specificity) of self-collected vaginal HPV DNA specimens versus provider-collected cervical HPV swabs as the gold standard. RESULTS: Of the 131 participants completing both the self- and provider-collected HPV tests, 21 cases of hrHPV were detected by the provider cervical swab (gold standard; 16.0% hrHPV prevalence); 15 of these cases were accurately detected by the self-collected vaginal swab (71.4% concordance) (Kappa = 0.75, 95% Confidence Interval [CI]: 0.59, 0.92; p<0.001). Compared to the provider-collected cervical hrHPV DNA sample (gold standard), the self-collected vaginal hrHPV DNA test demonstrated a sensitivity of 71.4% (95% CI: 0.52, 0.91; p = 0.0495) and specificity of 98.2% (95% CI: 0.96, 1.00; p<0.0001). Over 90% of participants endorsed a preference for the self-collected vaginal swab over provider-collected cervical swab. CONCLUSION: Self-collected vaginal swabs are highly acceptable to TM as a means to test for hrHPV DNA. Test performance of this self-collection method for hrHPV detection in TM is consistent with previous studies in cisgender females. Self-collected vaginal swab testing for hrHPV DNA represents a reasonable and patient-centered strategy for primary cervical cancer screening in TM patients unwilling to undergo provider collection of specimens via speculum exam.
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Self-collected swabs for high-risk HPV testing has been reported to be an acceptable option for transgender men.
“self-collected swabs for high-risk HPV testing has been reported to be an acceptable option for transgender men (371).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [371]
Some transmale participants cited feelings of gender dysphoria and difficulty positioning the body or swab for self-sampling as challenges of self-sampling.
“Some participants cited feelings of gender dysphoria and difficulty positioning the body or swab for self-sampling as challenges of self-sampling.”
From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [62]
Among transmales who had undergone both self-sampling and clinician sampling for HPV DNA, 90% expressed a preference for self-sampling.
“Among transmales who had undergone both self-sampling and clinician sampling for HPV DNA, 90% expressed a preference for self-sampling citing privacy, ease and self-empowerment as reasons for their preference.”
From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [62]
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HPV self-sampling for cervical cancer screening: a systematic review of values and preferences
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- Authors
- Reisner, S. L., Deutsch, M. B., Peitzmeier, S. M., White Hughto, J. M., Cavanaugh, T. P., Pardee, D. J., McLean, S. A., Panther, L. A., Gelman, M., Mimiaga, M. J., & Potter, J. E.
- Affiliations
- Boston Children's Hospital (US)
- University of California, San Francisco (US)
- Johns Hopkins University (US)
- Fenway Health (US)
- Beth Israel Deaconess Medical Center (US)
- Brown University (US)
- Corresponding author
- Reisner, Sari L.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-03-14
- Volume
- 13
- Issue
- 3
- Pages
- e0190172
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5851532
- OpenAlex
- W2791333130
- Cited by
- 126
- References
- 71
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 23 · 2023: 16 · 2022: 24 · 2021: 17 · 2020: 13 · 2019: 11
- FWCI
- 7.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (CER-1403-12625)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- high-risk HPV, HPV testing, self-collected vaginal swabs, cervical cancer screening, test performance, acceptability, concordance, sensitivity and specificity, DNA hybridization assay, gender-affirming hormone therapy
- MeSH terms
- Adult, Uterine Cervical Neoplasms, DNA, Viral, Female, Humans, Interviews as Topic, Male, Middle Aged, Patient Acceptance of Health Care, Self Care, Sensitivity and Specificity, Transsexualism, Vaginal Smears, Prevalence, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer, Young Adult, Transgender Persons
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