HPV Test Sampling Swabs: Pros, Cons and Guidance
Self-sampling for HPV testing has emerged as an important strategy to improve participation and access to cervical cancer screening. Allowing women to collect their own vaginal sample rather than needing a pelvic exam by a clinician can help overcome barriers like discomfort, embarrassment, scheduling difficulties and transportation issues. But what are the best devices and methods for self-sampling? Swabs present some advantages but also raise questions around accuracy and usability.
A variety of swabs have been evaluated for self-collection of vaginal samples for HPV testing, including cotton, flocked nylon, polyester and dacron. Cotton and flocked swabs are among the most common. Flocked swabs use smallfiber tufts that are designed to improve sample collection and release. Some key factors in swab selection include cost, comfort, efficiency in sampling cells from the vaginal walls and cervix, and release of material into the sample medium. The specific swab used may depend on the available HPV test and what it has been validated for.
Multiple studies have found good agreement between HPV test results from clinician-collected cervical samples and self-collected vaginal samples using various swabs. A systematic review and meta-analysis published in 2014 concluded that vaginal self-sampling showed similar sensitivity and specificity to detect underlying high-grade cervical lesions compared to clinician sampling, for PCR-based HPV assays.
Some studies have suggested that flocked swabs may collect more cellular material and yield somewhat higher analytical sensitivity for HPV compared to regular cotton swabs. However, other analyses found little difference. Overall, both cotton and flocked nylon swabs appear capable of collecting adequate samples for accurate HPV detection if used properly.
The World Health Organization (WHO) has issued recommendations supporting the use of self-sampling as an alternative means to increase participation in cervical cancer screening programs. In WHO guidelines published in 2021 on nucleic acid amplification tests for screening, as well as 2022 guidelines on self-care interventions, the organization recommends offering self-sampling with validated HPV tests as an additional approach along with provider-collected cervical samples. WHO states dry swabs or brushes are among the potential self-collection devices, though they note that self-collected vaginal samples tend to have lower sensitivity compared to clinician-taken cervical samples. Importantly, WHO guidance emphasizes that self-sampling strategies must use PCR-based tests that have been clinically validated specifically for use with self-collected vaginal samples, and that programs need to have systems to ensure follow-up management for women who screen HPV positive. WHO's recommendations lend further global endorsement to exploring implementation of self-sampling to expand cervical screening access, while underscoring the need to adhere to quality assurance and follow-up standards.
Where resources and infrastructure permit HPV testing, introducing opt-in self-sampling using validated swabs could help expand screening coverage and reduce cervical cancer burden. Ensuring quality specimen collection, affordableprocessed kits and effective follow-up for those with positive results are critical to realizing the benefits. Ongoing monitoring and evaluation of swab self-sampling implementation, costs, feasibility, and users’ experiences will further guide best practices.
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