![\"Untitled\"](\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2014\/10\/Untitled1-255x300.png\")
<\/a><\/p>\nFindings:<\/p>\n
–Urine detection of\u00a0HPV\u00a0had a pooled sensitivity of 87% (CI: 78-92%), and specificity of 94% (CI: 82-98%)<\/p>\n
–Urine detection of high risk HPV (15 serotypes assessed)\u00a0had\u00a0a pooled sensitivity of 77% (CI: 68-84%), and specificity of 88% (CI: 58-97%)<\/p>\n
–Urine detection of HPV\u00a016\/18 (the worst of the high-risk)\u00a0had a pooled sensitivity of 73% (CI: 56-86%), and specificity of 98% (CI: 91-100%)<\/p>\n
–Translation of above: the high specificity suggests that positive test results are 15 times more likely to occur in HPV positive women; the less-high sensitivity suggests that a negative test results would happen only 7 times more frequently in non-infected women. For those with HPV\u200b\u00a016\/18, positive test results are 37\u00a0times more likely to occur in HPV positive women and\u00a0negative test results would happen only 4\u00a0times more frequently in non-infected women<\/span><\/span>.<\/span><\/span><\/p>\n –Sensitivity for urinary\u00a0HPV\u00a0testing\u00a0increased with first void urine, on meta-regression analysis<\/p>\n So, we have moved away from annual pelvic exams for pap smears and gc\/ct (gonorrhea\/chlamydia) screening of yore\u00a0to much less frequent pap smears (beginning later, at age 21, and with frequency of every 3-5 years depending on age and HPV testing, and\u00a0with several European countries currently\u00a0assessing doing\u00a0only HPV testing without cytology). And now perhaps we are moving\u00a0to just doing urine testing for HPV in the future, maybe even as a sole initial screen. And we have transitioned from cervical gc\/ct\u00a0screening to urine gc\/ct\u00a0tests. In addition, women with vaginal discharges\u00a0are often appropriately\u00a0self-treating (eg for yeast) or getting medications for various infections without pelvic exams (eg, urine testing for trichomonas,\u00a0or simply empiric therapy for bacterial vaginosis\/BV). As a result,\u00a0as clinicians\u00a0we certainly are doing\u00a0many fewer pelvic exams\u00a0now\u00a0as compared to a couple of years ago. Though, clearly, pelvic exams are invasive, uncomfortable procedures that many women would love to avoid, I do have\u00a0one caveat. I have seen several episodes where a woman has potential PID and the clinician is comfortable with just sending a urine for GC\/chlamydia. The issue here is that GC and chlamydia are not the only culprits (the data are a bit murky here, since there are so many potentially infectious\u00a0pathogens in the vagina, but it is likely that PID is caused by\u00a0mycoplasmas, ureoplasmas, BV, and, very often, mixed organisms – both aerobic and anaerobic). And there can be other causes of acute pelvic pain besides PID (eg, ovarian cysts, appendicitis, endometriosis, assorted GI problems including bowel obstruction and constipation…). Again, I think it is great that we clinicians need to do fewer pelvic exams. My concern is that this mind-set may lead to not doing one when it is clinically indicated.<\/p>\n Geoff<\/p>\n","protected":false},"excerpt":{"rendered":" Whither the pelvic, again (HPV Screening) […]<\/p>\n