• Neha Pathak, Julie Dodds, Javier Zamora, and Khalid Khan.
• Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and dentistry, London E1 2AB, UK.
• BMJ. 2014 Jan 1;349:g5264.

ObjectiveTo determine the accuracy of testing for human papillomavirus (HPV) DNA in urine in detecting cervical HPV in sexually active women.DesignSystematic review and meta-analysis.Data SourcesSearches of electronic databases from inception until December 2013, checks of reference lists, manual searches of recent issues of relevant journals, and contact with experts.Eligibility CriteriaTest accuracy studies in sexually active women that compared detection of urine HPV DNA with detection of cervical HPV DNA.Data Extraction And SynthesisData relating to patient characteristics, study context, risk of bias, and test accuracy. 2 × 2 tables were constructed and synthesised by bivariate mixed effects meta-analysis.Results16 articles reporting on 14 studies (1443 women) were eligible for meta-analysis. Most used commercial polymerase chain reaction methods on first void urine samples. Urine detection of any HPV had a pooled sensitivity of 87% (95% confidence interval 78% to 92%) and specificity of 94% (95% confidence interval 82% to 98%). Urine detection of high risk HPV had a pooled sensitivity of 77% (68% to 84%) and specificity of 88% (58% to 97%). Urine detection of HPV 16 and 18 had a pooled sensitivity of 73% (56% to 86%) and specificity of 98% (91% to 100%). Metaregression revealed an increase in sensitivity when urine samples were collected as first void compared with random or midstream (P=0.004).LimitationsThe major limitations of this review are the lack of a strictly uniform method for the detection of HPV in urine and the variation in accuracy between individual studies.ConclusionsTesting urine for HPV seems to have good accuracy for the detection of cervical HPV, and testing first void urine samples is more accurate than random or midstream sampling. When cervical HPV detection is considered difficult in particular subgroups, urine testing should be regarded as an acceptable alternative.© Pathak et al 2014.

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