HPV screening in the urine of transpeople - A prevalence study

Sophie Pils; Jana Mlakar; Mario Poljak; Grega Gimpelj Domjanič; Ulrike Kaufmann; Stephanie Springer; Andreas Salat; Eva Langthaler; Elmar A Joura

doi:10.1016/j.eclinm.2022.101702

HPV screening in the urine of transpeople - A prevalence study

EClinicalMedicine. 2022 Oct 12:54:101702. doi: 10.1016/j.eclinm.2022.101702. eCollection 2022 Dec.

Authors

Sophie Pils¹, Jana Mlakar², Mario Poljak², Grega Gimpelj Domjanič², Ulrike Kaufmann¹, Stephanie Springer¹, Andreas Salat³, Eva Langthaler⁴, Elmar A Joura¹

Affiliations

¹ Department of Obstetrics and Gynaecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
² Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
³ Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
⁴ Department of Pathology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.

Abstract

Background: There is limited data on human papillomaviruses (HPV) prevalence in transpeople due to low acceptance rate of screening methods. HPV tests from self-collected urine are gender-neutral, have a high acceptance, and have a comparable accuracy in females to clinician-collected samples. The aim of this study was to evaluate both the HPV prevalence in the urine in a large cohort of 200 transpeople with common risk profiles and the acceptability of such screening method.

Methods: The study was conducted at the outpatient clinic for transpeople at the Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria. 200 transpeople have been enrolled between May and October 2021. Inclusion criteria were gender identity dysphoria, age over 18 years, and adequate language skills.Subjects were asked to answer a survey concerning gender identity, established risk factors for HPV infections as well as their preference regarding urine or provider-collected cytology-/HPV-based screening, and to provide a urine sample. Five patients not able to provide urine were excluded. HPV genotyping was performed using a validated multiplex real-time PCR assay, which simultaneously detects 28 HPV genotypes. This trial is registered at ClinicalTrials.gov, NCT04864951.

Findings: Overall HPV positivity was 19·0% (37/195), 24·2% in female to male, 11·8% in male to female, 26·3% in genderqueer/non binary/other subjects, 27·9% in subjects currently having a cervix, and 26·0% in subjects born with cervix. Independent of gender reassignment surgery, being born with a cervix was associated with a higher risk of HPV infections (p = 0·008), yet 42·3% (44/104) have never attended cervical cancer screening. Overall, 79·0% (154/195) of transpeople would prefer urine HPV tests to provider-collected HPV screening.

Interpretation: HPV testing in self-collected urine samples provides a unique opportunity for screening of this hard-to-reach population and should be evaluated in further studies.

Funding: None.

Keywords: FtM; HPV prevalence; MtF; Non binary; Transgender; Transpeople.

Associated data

ClinicalTrials.gov/NCT04864951