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A growing proportion of head and neck cancer (HNC), especially oropharyngeal cancer (OPC), is caused by human papillomavirus (HPV). There are several markers for HPV‐driven HNC, one being HPV early antigen serology. We aimed to investigate the diagnostic accuracy of HPV serology and its performance across patient characteristics. Data from the VOYAGER consortium was used, which comprises five studies on HNC from North America and Europe. Diagnostic accuracy, that is, sensitivity, specificity, Cohen's kappa and correctly classified proportions of HPV16 E6 serology, was assessed for OPC and other HNC using p16INK4a immunohistochemistry (p16), HPV in situ hybridization (ISH) and HPV PCR as reference methods. Stratified analyses were performed for variables including age, sex, smoking and alcohol use, to test the robustness of diagnostic accuracy. A risk‐factor analysis based on serology was conducted, comparing HPV‐driven to non‐HPV‐driven OPC. Overall, HPV serology had a sensitivity of 86.8% (95% CI 85.1‐88.3) and specificity of 91.2% (95% CI 88.6‐93.4) for HPV‐driven OPC using p16 as a reference method. In stratified analyses, diagnostic accuracy remained consistent across sex and different age groups. Sensitivity was lower for heavy smokers (77.7%), OPC without lymph node involvement (74.4%) and the ARCAGE study (66.7%), while specificity decreased for cases with <10 pack‐years (72.1%). The risk‐factor model included study, year of diagnosis, age, sex, BMI, alcohol use, pack‐years, TNM‐T and TNM‐N stage. HPV serology is a robust biomarker for HPV‐driven OPC, and its diagnostic accuracy is independent of age and sex. Future research is suggested on the influence of smoking on HPV antibody levels. [ABSTRACT FROM AUTHOR]

Background: Universal anorectal testing for Chlamydia trachomatis (chlamydia) among women is not recommended in many countries, while anorectal chlamydia infections are common. Missed anorectal infections might cause sequelae at the genital site if autoinoculation from the anorectum is possible, but evidence is limited. This study investigates the association between potentially missed anorectal infections and subsequent genital chlamydia infections in women, using not being tested at the anorectal site as a proxy for having a potentially missed anorectal infection.Methods: We included all women with a repeat chlamydia test within 1 year (with at least a genital test) from the Dutch sexual health centre surveillance between 2014 and 2019. Multilevel logistic regression analyses were used to identify determinants of genital chlamydia infection at the repeat test, with anorectal testing at the previous chlamydia test as the main determinant.Results: A total of 40 217 women were included in the analyses, of whom 15.4% tested chlamydia-positive genitally at their second test. Not being tested anorectally at the first test was an independent risk factor for genital chlamydia infection at the repeat test (adjusted OR 1.24, 95% CI 1.15 to 1.33). This association was in the same range as most other significant risk factors in the model: low education level, no condom use, STI symptoms and previous STI diagnosis. Young age (<20 years) (2.67, 2.39-2.98) and those who received partner notification (3.11, 2.91-3.31) showed stronger associations. The findings were robust; correcting for interactions and a sensitivity analysis stratifying by chlamydia infection at first visit did not show significant differences in the adjusted OR of not being tested anorectally at first test.Conclusion: The results are suggestive of an autoinoculation process from the anorectal to the genital anatomical site in women. To enhance chlamydia control, future studies on the role of extragenital testing and autoinoculation in chlamydia transmission are needed. [ABSTRACT FROM AUTHOR]

Background Many European countries do not have comprehensive sexually transmitted infection (STI) surveillance in place. The objective was to investigate whether national probability sample surveys are useful in placing STI surveillance into perspective. Methods We used data from the Dutch national cross-sectional probability sample survey on sexual health 2016 (18–34-year-old sexually active individuals). Descriptive analyses were performed regarding STI testing (last year). Test numbers were extrapolated from the survey and compared with surveillance data from sexual health centres (SHCs) (complete) and general practitioners (GPs) (representative estimates from 7% of all GPs). Statistical differences in characteristics between SHC attendees and general population (according to weighted survey participants) were determined using χ2 statistic. Predictors of recent testing at GPs or SHCs were determined using multinomial multivariable logistic regression. Results Of the 17 222 survey invitees, 3217 (19%) were eligible for analyses. Testing uptake was higher in women (17.2%, 14.8–20.0%) than men (11.5%, 9.1–14.3%). The majority of tests were conducted by GPs followed by SHCs and hospitals. Number of tests extrapolated from the survey was similar to SHC surveillance data, but higher than GP surveillance data (women only). Testing at SHCs was associated with high-risk behaviour and with living in highly urbanized areas. Low education level and older age were, next to high-risk behaviour factors, determinants of testing at GPs. Conclusions National probability sample surveys are useful for placing STI surveillance data into perspective by providing insights in testing patterns in the general population and identifying strengths and weaknesses of national surveillance systems. [ABSTRACT FROM AUTHOR]