In Reply Open Access

In Reply.—Self-sampling for human papillomavirus (HPV) has been widely recognized as an optional method for primary cervical cancer screening that could overcome obstacles including travel inconvenience, personal privacy issues, and social-psychological factors.^1,2  The most common self-sampling methods are collecting vaginal secretions or using urine.^2,3  Recently, our study⁴  found that HPV detection based on vulvar sampling might also provide acceptable diagnostic efficacy in cervical cancer screening compared with cervical samples.

In the letter by Tommy Richard Sun-wing Tong, MD, the author noted that HPV infection was inconsistent between cervical and vulvar specimens in our study, and suggested that the possible reason was that the patients had urinated or cleaned the introitus before detection. However, similar to a previous study,⁵  our results found that HPV infection was more frequently observed in the vulva than in the cervix. We think that another possible reason might be the difference in HPV clearing status between the 2 sites. Nevertheless, there was no significant difference in HPV infection in patients with cervical intraepithelial neoplasia (CIN) 2+ and CIN3+ between sites. It is worth noting that the purpose of cervical cancer screening is to detect CIN3+ as much as possible, not just HPV infection. As the vulvar sampling was performed by the doctor in our study, further research should be carried out for conforming suitable sampling devices and comparison between self and doctor vulvar sampling in the future, in the hope that vulvar self-sampling will become an optional method for cervical cancer screening and accelerate achieving the World Health Organization’s goal of eliminating cervical cancer.