AIDS and Behavior

, Volume 21, Issue 7, pp 2141–2146 | Cite as

Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women

  • Sarah E. Woolf-KingEmail author
  • Winnie Muyindike
  • Marcia M. Hobbs
  • Adrine Kusasira
  • Robin Fatch
  • Nneka Emenyonu
  • Mallory O. Johnson
  • Judith A. Hahn
Original Paper


The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.


Self-report Condom use Biomarker Prostate specific antigen HIV 


La viabilidad práctica de utilizar un antígeno prostático específico (PSA por sus siglas en inglés) como marcador biológico tras exposición a semen fue analizado en mujeres de Uganda infectadas con el virus del VIH. Los fluidos vaginales fueron obtenidos por medio de auto recolección con torundas vaginales y se utilizó una prueba cualitativa rápida (ABAcard®p30) para detectar el PSA. Las muestras fueron procesadas in situ por técnicos laboratoristas entrenados y las muestras de PSA con resultado positivo fueron comparadas con las de mujeres que auto reportaron haber practicado sexo vaginal sin protección (UVS en inglés) en las últimas 48 horas. Un total de 77 mujeres presentaron 126 muestras para análisis de PSA en hasta tres consultas. De estas muestras, el 31 % (n = 39/126) resultaron positivas con PSA y un 64 % (n = 25/39) de las muestras positivas con PSA estaban acompañadas de un auto reporte en el cual las participantes reportaron no haber practicado sexo vaginal durante la consulta en el cual se recolectó el PSA. No se reportaron dificultades con la recolección, almacenamiento o el procesamiento de las muestras. Estos resultados ofrecen datos preliminares en altos niveles de sexo vaginal sin protección no declarados entre mujeres Ugandesas infectadas con el VIH por medio de la utilización de métodos prácticamente factibles para la recolección y procesamiento de PSA.



Sources of Support: This work was supported by the following Grants: UCSF CFAR Mentored Scientist Award (PI: Woolf-King). NIAAA K01AA021671 (PI: Woolf-King). NIAAA R01, AA018631 (PI: Hahn). NIAAA U01 AA020776 (PI: Hahn). NIAAA K24AA022586 (PI: Hahn). NIDA K24DA037034 (PI: Johnson). Laboratory support and training for PSA testing was provided by the Southeastern Sexually Transmitted Infections Cooperative Research Center Grant (U19-AI031496) and the University of North Carolina Center for AIDS Research (P30 AI50410).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Foss AM, Hossain M, Vickerman PT, Watts CH. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect. 2007;83:510–6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gallo MF, Steiner MJ, Hobbs MM, Warner L, Jamieson DJ, Macaluso M. Biological markers of sexual activity: tools for improving measurement in HIV/sexually transmitted infection prevention research. Sex Transm Dis. 2013;40:447–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Hahn JA, Emenyonu NI, Fatch R, Muyindike WR, Kekiibina A, Carrico AW, et al. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction. 2016;111:272–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509–18.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tourangeau R, Yan T. Sensitive questions in surveys. Psychol Bull. 2007;133:859–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21:1074–90.CrossRefPubMedGoogle Scholar
  7. 7.
    Gallo MF, Behets FM, Steiner MJ, Hobbs MM, Hoke TH, Van Damme K, et al. Prostate-specific antigen to ascertain reliability of self-reported coital exposure to semen. Sex Transm Dis. 2006;33:476–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Hobbs MM, Steiner MJ, Rich KD, Gallo MF, Alam A, Rahman M, et al. Good performance of rapid prostate-specific antigen test for detection of semen exposure in women: implications for qualitative research. Sex Transm Dis. 2009;36:501–6.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mauck CK. Biomarkers of semen exposure. Sex Transm Dis. 2009;36:S81–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Gallo MF, Behets FM, Steiner MJ, Thomsen SC, Ombidi W, Luchters S, et al. Validity of self-reported ‘safe sex’ among female sex workers in Mombasa, Kenya—PSA analysis. Int J STD AIDS. 2007;18:33–8.CrossRefPubMedGoogle Scholar
  11. 11.
    McCoy SI, Ralph LJ, Padian NS, Minnis AM. Are hormonal contraceptive users more likely to misreport unprotected sex? Evidence from a biomarker validation study in Zimbabwe. AIDS Behav. 2014;18:2259–64.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Minnis AM, Steiner MJ, Gallo MF, Warner L, Hobbs MM, van der Straten A, et al. Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe. Am J Epidemiol. 2009;170:918–24.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mose F, Newman LP, Njunguna R, Tamooh H, John-Stewart G, Farquhar C, et al. Biomarker evaluation of self-reported condom use among women in HIV-discordant couples. Int J STD AIDS. 2013;24:537–40.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med. 2009;36:452–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gallo MF, Snead MC, Black CM, Brown TM, Kourtis AP, Jamieson DJ, et al. Optimal methods for collecting and storing vaginal specimens for prostate-specific antigen testing in research studies. Contraception. 2013;87:830–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Brown JL, Vanable PA. Alcohol use, partner type, and risky sexual behavior among college students: findings from an event-level study. Addict Behav. 2007;32:2940–52.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Thomsen SC, Gallo MF, Ombidi W, Omungo Z, Janowitz B, Hawken M, et al. Randomised controlled trial on whether advance knowledge of prostate-specific antigen testing improves participant reporting of unprotected sex. Sex Transm Infect. 2007;83:419–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Valappil T, Kelaghan J, Macaluso M, Artz L, Austin H, Fleenor ME, et al. Female condom and male condom failure among women at high risk of sexually transmitted diseases. Sex Transm Dis. 2005;32:35–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Bajunirwe F, Haberer JE, Boum Y 2nd, Hunt P, Mocello R, Martin JN, et al. Comparison of self-reported alcohol consumption to phosphatidylethanol measurement among HIV-infected patients initiating antiretroviral treatment in southwestern Uganda. PLoS One. 2014;9:e113152.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    van der Straten A, Stadler J, Luecke E, Laborde N, Hartmann M, Montgomery ET. Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE-C qualitative study in Johannesburg, South Africa. J Int AIDS Soc. 2014;17:19146.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Carter MW, Bailey A, Snead MC, Costenbader E, Townsend M, Macaluso M, et al. Exploring discordance between biologic and self-reported measures of semen exposure: a qualitative study among female patients attending an STI clinic in Jamaica. AIDS Behav. 2013;17:728–36.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Marshall R. The predictive value of simple rules for combining two diagnostic tests. Biometrics. 1989;1:1213–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sarah E. Woolf-King
    • 1
    Email author
  • Winnie Muyindike
    • 2
  • Marcia M. Hobbs
    • 3
  • Adrine Kusasira
    • 2
  • Robin Fatch
    • 1
  • Nneka Emenyonu
    • 1
  • Mallory O. Johnson
    • 1
  • Judith A. Hahn
    • 1
  1. 1.Department of MedicineUniversity of California, San Francisco (UCSF)San FranciscoUSA
  2. 2.Mbarara University of Science and Technology (MUST)MbararaUganda
  3. 3.School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA

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