Journal of Community Health

, Volume 40, Issue 3, pp 379–386 | Cite as

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

  • Erik J. Nelson
  • John Hughes
  • J. Michael Oakes
  • Bharat Thyagarajan
  • James S. Pankow
  • Shalini L. Kulasingam
Original Paper


Submission of vaginal samples collected at home could remove barriers that women face in getting screened for cervical cancer. From December 2013 to January 2014, women aged 21–30 years were recruited online to participate in either (1) self-collected testing for human papillomavirus (HPV) infection and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. Demographics, risk factors, testing perceptions, and satisfaction with self-collected testing were assessed with online questionnaires. Women who performed self-collection were sent a home sampling kit by US mail, which was returned via US mail for HPV testing. A total of 197 women were enrolled, with 130 completing the online survey and 67 participating in both the survey and self-collection. Of the 67 women who were sent kits, 62 (92.5 %) were returned for testing. Sixty kits contained a sample sufficient for testing. The overall prevalence of HPV infection was 17.8 %, however 6 women (9.7 %) were infected with >1 type of HPV. Women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey, including ease of sampling (87.1 vs. 18.9 %), no pain during sampling (72.6 vs. 5.6 %), and lack of embarrassment (67.7 vs. 12.9 %). A high prevalence of HPV infection was demonstrated among women recruited via the internet. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds.


Human papillomavirus testing Self-collection Cervical cancer Internet recruitment 



This study was supported by the J.B. Hawley Student Research Award from the University of Minnesota School of Public Health and by the Minnesota Medical Foundation through Grant #4120-9227-12.

Conflict of interest

There are no conflicts of interest for any authors of this paper.


  1. 1.
    Peto, J., Gilham, C., Deacon, J., Taylor, C., Evans, C., Binns, W., et al. (2004). Cervical HPV infection and neoplasia in a large population-based prospective study: The Manchester cohort. British Journal of Cancer, 91(5), 942–953.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Schiffman, M., Castle, P. E., Jeronimo, J., Rodriguez, A. C., & Wacholder, S. (2007). Human papillomavirus and cervical cancer. Lancet, 370(9590), 890–907.CrossRefPubMedGoogle Scholar
  3. 3.
    de Sanjose, S., Diaz, M., Castellsague, X., Clifford, G., Bruni, L., Munoz, N., et al. (2007). Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: A meta-analysis. The Lancet infectious diseases, 7(7), 453–459.CrossRefPubMedGoogle Scholar
  4. 4.
    Smith, J. S., Gilbert, P. A., Melendy, A., Rana, R. K., & Pimenta, J. M. (2011). Age-specific prevalence of human papillomavirus infection in males: A global review. Journal of Adolescent Health, 48(6), 540–552.CrossRefPubMedGoogle Scholar
  5. 5.
    Trottier, H., & Franco, E. L. (2006). The epidemiology of genital human papillomavirus infection. Vaccine, 24(Suppl 1), S1–S15.PubMedGoogle Scholar
  6. 6.
    Clifford, G. M., Gallus, S., Herrero, R., Munoz, N., Snijders, P. J., Vaccarella, S., et al. (2005). Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: A pooled analysis. Lancet, 366(9490), 991–998.CrossRefPubMedGoogle Scholar
  7. 7.
    Moscicki, A. B., Schiffman, M., Kjaer, S., Villa, L. L. (2006). Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine, 24(Suppl 3), S3/42–51.Google Scholar
  8. 8.
    Walboomers, J. M., Jacobs, M. V., Manos, M. M., Bosch, F. X., Kummer, J. A., Shah, K. V., et al. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology, 189(1), 12–19.CrossRefPubMedGoogle Scholar
  9. 9.
    Cuschieri, K. S., Cubie, H. A., Whitley, M. W., Gilkison, G., Arends, M. J., Graham, C., et al. (2005). Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study. Journal of Clinical Pathology, 58(9), 946–950.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Priebe, A. M. (2013). 2012 cervical cancer screening guidelines and the future role of HPV testing. Clinical Obstetrics and Gynecology, 56(1), 44–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Cuzick, J., Arbyn, M., Sankaranarayanan, R., Tsu, V., Ronco, G., Mayrand, M. H., et al. (2008). Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine, 26(Suppl 10), K29–K41.CrossRefPubMedGoogle Scholar
  12. 12.
    U.S. Food and Drug Administration. (2014). FDA approves first human papillomavirus test for primary cervical cancer screening.;
  13. 13.
    Gravitt, P. E., Belinson, J. L., Salmeron, J., & Shah, K. V. (2011). Looking ahead: A case for human papillomavirus testing of self-sampled vaginal specimens as a cervical cancer screening strategy. International Journal of Cancer, 129(3), 517–527.CrossRefGoogle Scholar
  14. 14.
    Kahn, J. A., Slap, G. B., Huang, B., Rosenthal, S. L., Wanchick, A. M., Kollar, L. M., et al. (2004). Comparison of adolescent and young adult self-collected and clinician-collected samples for human papillomavirus. Obstetrics and Gynecology, 103(5 Pt 1), 952–959.CrossRefPubMedGoogle Scholar
  15. 15.
    Harper, D. M., Noll, W. W., Belloni, D. R., & Cole, B. F. (2002). Randomized clinical trial of PCR-determined human papillomavirus detection methods: Self-sampling versus clinician-directed–biologic concordance and women’s preferences. American Journal of Obstetrics and Gynecology, 186(3), 365–373.CrossRefPubMedGoogle Scholar
  16. 16.
    Lorenzato, F. R., Singer, A., Ho, L., Santos, L. C., Batista Rde, L., Lubambo, T. M., et al. (2002). Human papillomavirus detection for cervical cancer prevention with polymerase chain reaction in self-collected samples. American journal of Obstetrics and Gynecology, 186(5), 962–968.CrossRefPubMedGoogle Scholar
  17. 17.
    Gage, J. C., Partridge, E. E., Rausa, A., Gravitt, P. E., Wacholder, S., Schiffman, M., et al. (2011). Comparative performance of human papillomavirus DNA testing using novel sample collection methods. Journal of Clinical Microbiology, 49(12), 4185–4189.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Gravitt, P. E., Lacey, J. V, Jr, Brinton, L. A., Barnes, W. A., Kornegay, J. R., Greenberg, M. D., et al. (2001). Evaluation of self-collected cervicovaginal cell samples for human papillomavirus testing by polymerase chain reaction. Cancer Epidemiology Biomarkers and Prevention, 10(2), 95–100.Google Scholar
  19. 19.
    Dannecker, C., Siebert, U., Thaler, C. J., Kiermeir, D., Hepp, H., & Hillemanns, P. (2004). Primary cervical cancer screening by self-sampling of human papillomavirus DNA in internal medicine outpatient clinics. Annals of Oncology, 15(6), 863–869.CrossRefPubMedGoogle Scholar
  20. 20.
    Dzuba, I. G., Diaz, E. Y., Allen, B., Leonard, Y. F., Lazcano Ponce, E. C., Shah, K. V., et al. (2002). The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening. Journal of Womens Health and Gender Based Medicine, 11(3), 265–275.CrossRefGoogle Scholar
  21. 21.
    Kahn, J. A., Bernstein, D. I., Rosenthal, S. L., Huang, B., Kollar, L. M., Colyer, J. L., et al. (2005). Acceptability of human papillomavirus self testing in female adolescents. Sexually Transmitted Infections, 81(5), 408–414.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Ortiz, A. P., Alejandro, N., Perez, C. M., Otero, Y., Soto-Salgado, M., Palefsky, J. M., et al. (2012). Acceptability of cervical and anal HPV self-sampling in a sample of Hispanic women in Puerto Rico. Puerto Rico Health Sciences Journal, 31(4), 205–212.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Pew Research Internet Project. (2014). Social networking fact sheet. Washington, DC.;
  24. 24.
    Scarinci, I. C., Litton, A. G., Garces-Palacio, I. C., Partridge, E. E., & Castle, P. E. (2013). Acceptability and usability of self-collected sampling for HPV testing among African-American women living in the Mississippi Delta. Womens Health Issues, 23(2), e123–e130.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Winer, R. L., Feng, Q., Hughes, J. P., Yu, M., Kiviat, N. B., O’Reilly, S., et al. (2007). Concordance of self-collected and clinician-collected swab samples for detecting human papillomavirus DNA in women 18 to 32 years of age. Sexually Transmitted Diseases, 34(6), 371–377.PubMedGoogle Scholar
  26. 26.
    Jones, H. E., Brudney, K., Sawo, D. J., Lantigua, R., & Westhoff, C. L. (2012). The acceptability of a self-lavaging device compared to pelvic examination for cervical cancer screening among low-income women. Journal of Womens Health (Larchmt), 21(12), 1275–1281.CrossRefGoogle Scholar
  27. 27.
    Quincy, B. L., Turbow, D. J., & Dabinett, L. N. (2012). Acceptability of self-collected human papillomavirus specimens as a primary screen for cervical cancer. Journal of Obstetrics and Gynaecology, 32(1), 87–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Nelson, E. J., Hughes, J., Oakes, J. M., Pankow, J. S., & Kulasingam, S. (2014). Estimation of geographic variation in human papillomavirus vaccine uptake in men and women: An online survey using facebook recruitment. Journal of Medical Internet Research, 16(9), e198.Google Scholar
  29. 29.
    Ralston Howe, E., Li, Z., McGlennen, R. C., Hellerstedt, W. L., & Downs, L. S. (2009). Type-specific prevalence and persistence of human papillomavirus in women in the United States who are referred for typing as a component of cervical cancer screening. American Journal of Obstetrics and Gynecology, 200(3), 245.e1–245.e7.CrossRefGoogle Scholar
  30. 30.
    Ogilvie, G. S., Mitchell, S., Sekikubo, M., Biryabarema, C., Byamugisha, J., Jeronimo, J., et al. (2013). Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. International Journal of Gynecology and Obstetrics, 122(2), 118–123.CrossRefPubMedGoogle Scholar
  31. 31.
    Ostergaard, L., Andersen, B., Olesen, F., & Moller, J. K. (1998). Efficacy of home sampling for screening of Chlamydia trachomatis: Randomised study. BMJ, 317(7150), 26–27.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Richardson, E., Sellors, J. W., Mackinnon, S., Woodcox, V., Howard, M., Jang, D., et al. (2003). Prevalence of Chlamydia trachomatis infections and specimen collection preference among women, using self-collected vaginal swabs in community settings. Sexually Transmitted Diseases, 30(12), 880–885.CrossRefPubMedGoogle Scholar
  33. 33.
    Cantrell, M. A., & Lupinacci, P. (2007). Methodological issues in online data collection. Journal of Advanced Nursing, 60(5), 544–549.CrossRefPubMedGoogle Scholar
  34. 34.
    Rhodes, S. D., Bowie, D. A., & Hergenrather, K. C. (2003). Collecting behavioural data using the world wide web: Considerations for researchers. Journal of Epidemiology and Community Health, 57(1), 68–73.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Goldhaber-Fiebert, J. D., Stout, N. K., Salomon, J. A., Kuntz, K. M., & Goldie, S. J. (2008). Cost-effectiveness of cervical cancer screening with human papillomavirus DNA testing and HPV-16,18 vaccination. Journal of the National Cancer Institute, 100(5), 308–320.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Erik J. Nelson
    • 1
  • John Hughes
    • 2
  • J. Michael Oakes
    • 3
  • Bharat Thyagarajan
    • 4
  • James S. Pankow
    • 3
  • Shalini L. Kulasingam
    • 3
  1. 1.Department of Epidemiology, College for Public Health and Social JusticeSaint Louis UniversitySt. LouisUSA
  2. 2.Division of Biostatistics, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  3. 3.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of Laboratory Medicine and PathologyUniversity of MinnesotaMinneapolisUSA

Personalised recommendations