Infectious Diseases – Urine as a sample type

Problem:
Infectious diseases, including sexually transmitted infections (STIs) remain a global health challenge. Human papillomavirus (HPV), the most common STI, is a major cause of cervical cancer and responsible for causing an estimated of 530,000 cases annually (1). Further, 357 million new cases of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and Trichomonas vaginalis (TV) are recorded in people aged 15 to 49 yearly (1).

Limitations of traditional screening methods:
As some STIs do not present any symptoms, routine screening is critical for prevention and control. However, traditional testing methods can be invasive, time intensive, and require a clinician to perform. Moreover, many individuals often feel embarrassed or uncomfortable to discuss sexual activity openly (2). As a result, only a proportion of cases are detected.

Urine as a sample type:
Given the challenges with current screening methods, non or minimally invasive techniques are gaining momentum (2). Urine, in particular first-void/first-catch urine (first 20ml of urine flow) has shown great promise in STI screening and can reach a wider population (3,4). Urine as a sample type for STI screening has several benefits - it is considered easy to collect, acceptable and non-invasive (2,5). Many STIs, including HPV, CT, NG, TV have been detected in urine (3,4).

References:

1. WHO. Global health sector strategy on sexually transmitted infections 2016-2021: World Heal Organ, 2016:63.
2. Paudyal P, Llewellyn C, Lau J, Mahmud M, Smith H. Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients' experiences. PLoS One. 2015;10(4):e0124310. doi: 10.1371/journal.pone.0124310. eCollection 2015. Review. PubMed PMID: 25909508; PubMed Central PMCID: PMC4409059.
3. Ducancelle A, Reiser J, Pivert A, Le Guillou-Guillemette H, Le Duc-Banaszuk AS, Lunel-Fabiani F. Home-based urinary HPV DNA testing in women who do not attend cervical cancer screening clinics. J Infect. 2015 Sep;71(3):377-84. doi: 10.1016/j.jinf.2015.05.001. Epub 2015 May 9. PubMed PMID: 25964233.
4. De Baetselier I, Smet H, Abdellati S, De Deken B, Cuylaerts V, Reyniers T, Vuylsteke B, Crucitti T. Evaluation of the 'Colli-Pee', a first-void urine collection device for selfsampling at home for the detection of sexually transmitted infections, versus a routine clinic-based urine collection in a one-to-one comparison study design: efficacy and acceptability among MSM in Belgium. BMJ Open. 2019 Apr 3;9(4):e028145. doi: 10.1136/bmjopen-2018-028145. PubMed PMID: 30948618; PubMed Central PMCID: PMC6500257.
5. Shih SL, Graseck AS, Secura GM, Peipert JF. Screening for sexually transmitted infections at home or in the clinic?. Curr Opin Infect Dis. 2011 Feb;24(1):78-84. doi: 10.1097/QCO.0b013e32834204a8. Review. PubMed PMID: 21124216; PubMed Central PMCID: PMC3125396