Variation of Saliva Sampling Procedures in Detecting SARS-CoV2 with Real Time Polymerase Chain Reaction: A Scoping Review


  • Dewi Suryani Fakultas Kedokteran Universitas Mataram
  • Devi Rahmadhona
  • Prima Belia Fathana
  • Indah Sapta Wardani
  • Ika Nurfiria Tauhida
  • Mohammad Rizki



sample, saliva, detection SARS COV-19, RT-PCR


Background: Currently there is a rise in the study of saliva as alternative clinical samples for the detection of SARS-CoV2 as it is considered less invasive, able to be obtained independently by patients and does not cause discomfort compared to nasopharyngeal swab (NPS). Nevertheless, there has been an inconsistency of methods applied in sample collection, storage and laboratory assay from previous research. As the pre analytical phase may influence diagnostic result, therefore  this scoping review would like to identify the varation approach of saliva collection methods conducted by previous studies.

Study Design: We conducted a scoping review of the literature in 3 databases (PubMed, Science Direct and Google Scholar) and included articles published bewteen January 2020 until March 2021.

Results: This review included 22 publications that met the inclusion criteria. All articles compared saliva with nasopharyngeal swabs. There were variations of sample collection approach which include type of saliva collected, type of container, the use of presrvative or stabilizing agent, time and volume of saliva collected and requirements for patients prior to sample collection. Moreover, not all study included a detailed information regarding salivary collection methods.

Conclusion: Information regarding saliva sample collection and prepartion is required to not only be reproduced by following research but also to determine the best approach for optimal outcome.


1. WHO. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases. 2020 [cited 15 October 2020]. Available from:

2. Tang Y-W, Schmitz JE, Persing DH, Stratton CW, McAdam AJ. Laboratory Diagnosis of COVID-19: Current Issues and Challenges. Journal of Clinical Microbiology. 2020; 58(6):e00512-20. DOI:

3. Yoon JG, Yoon J, Song JY, Yoon S-Y, Lim CS, Seong H, et al. Clinical Significance of a High SARS-CoV-2 Viral Load in the Saliva. Journal of Korean Medical Science. 2020; 35(20):e195. DOI:10.3346/jkms.2020.35.e195.

4. Sueki A, Matsuda K, Yamaguchi A, Uehara M, Sugano M, Uehara T, et al. Evaluation of saliva as diagnostic materials for influenza virus infection by PCR-based assays. Clinica Chimica Acta. 2016; 453:71-74. DOI:

5. Yoon J, Yun SG, Nam J, Choi S-H, Lim CS. The use of saliva specimens for detection of influenza A and B viruses by rapid influenza diagnostic tests. Journal of Virological Methods. 2017; 243:15-19. DOI:

6. To KKW, Yip CCY, Lai CYW, Wong CKH, Ho DTY, Pang PKP, et al. Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: a diagnostic validity study. Clinical Microbiology and Infection. 2019; 25(3):372-378. DOI:

7. Sri Santosh T, Parmar R, Anand H, Srikanth K, Saritha M. A Review of Salivary Diagnostics and Its Potential Implication in Detection of Covid-19. Cureus. 2020; 12(4):e7708-e7708. DOI:10.7759/cureus.7708.

8. Canete MG, Valenzuela IM, Garces PC, Masso IC, Gonzalez MJ, Providel SG. Saliva Sample for the Massive Screening of SARS-CoV-2 Infection: A Systematic Review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021; 13(5):540-548. DOI:

9. Fakheran O, Dehghannejad M, Khademi A. Saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients: a scoping review. Infectious Diseases of Poverty. 2020; 9(100) DOI:

10. Kapoor P, Chowdhry A, Kharbanda OP, Popli DB, Gautam K, Saini V. Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions. BDJ Open. 2021; 7(8) DOI:

11. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8(1):19-32. DOI:10.1080/1364557032000119616.

12. Azzi L, Carcano G, Gianfagna F, Grossi P, Gasperina DD, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. Journal of Infection. 2020; 81(1):e45-e50. DOI:

13. Pasomsub E, Watcharananan SP, Boonyawat K, Janchompoo P, Wongtabtim G, Suksuwan W, et al. Saliva sample as a non-invasive specimen for the diagnosis of coronavirus disease 2019: a cross-sectional study. Clinical Microbiology and Infection. 2021; 27(2):285.e1-285.e4. DOI:

14. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ. 2020; 369:m1443. DOI:10.1136/bmj.m1443.

15. Medeiros da Silva RC, Nogueira Marinho LC, de Araújo Silva DN, Costa de Lima K, Pirih FQ, Luz de Aquino Martins AR. Saliva as a possible tool for the SARS-CoV-2 detection: A review. Travel Medicine and Infectious Disease. 2020; 38:101920. DOI:

16. Khiabani K, Amirzade-Iranaq MH. Are saliva and deep throat sputum as reliable as common respiratory specimens for SARS-CoV-2 detection? A systematic review and meta-analysis. American Journal of Infection Control. 2021; 49(9):1165-1176. DOI:

17. Fernandes LL, Pacheco VB, Borges L, Athwal HK, de Paula Eduardo F, Bezinelli L, et al. Saliva in the Diagnosis of COVID-19: A Review and New Research Directions. Journal of Dental Research. 2020 [cited 2021/10/14]; 99(13):1435-1443. DOI:10.1177/0022034520960070.

18. Khurshid Z, Zohaib S, Najeeb S, Zafar MS, Slowey PD, Almas K. Human Saliva Collection Devices for Proteomics: An Update. International Journal of Molecular Sciences. 2016; 17(6) DOI:10.3390/ijms17060846.

19. Hung DL-L, Li X, Chiu KH-Y, Yip CC-Y, To KK-W, Chan JF-W, et al. Early-Morning vs Spot Posterior Oropharyngeal Saliva for Diagnosis of SARS-CoV-2 Infection: Implication of Timing of Specimen Collection for Community-Wide Screening. Open Forum Infectious Diseases. 2020 [cited 10/15/2021]; 7(6) DOI:10.1093/ofid/ofaa210.

20. Ather A, Parolia A, Ruparel NB. Efficacy of Mouth Rinses Against SARS-CoV-2: A Scoping Review. Frontiers in Dental Medicine. 2021; 2(648547) DOI:doi: 10.3389/fdmed.2021.648547.

21. Williams E, Bond K, Zhang B, Putland M, Williamson Deborah A, McAdam Alexander J. Saliva as a Noninvasive Specimen for Detection of SARS-CoV-2. Journal of Clinical Microbiology. 2020 [cited 2021/10/14]; 58(8):e00776-20. DOI:10.1128/JCM.00776-20.

22. Jamal AJ, Mozafarihashjin M, Coomes E, Powis J, Li AX, Paterson A, et al. Sensitivity of Nasopharyngeal Swabs and Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2. Clinical Infectious Diseases. 2021 [cited 10/15/2021]; 72(6):1064-1066. DOI:10.1093/cid/ciaa848.

23. To KK-W, Tsang OT-Y, Yip CC-Y, Chan K-H, Wu T-C, Chan JM-C, et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clinical Infectious Diseases. 2020 [cited 10/15/2021]; 71(15):841-843. DOI:10.1093/cid/ciaa149.

24. To KK-W, Tsang OT-Y, Leung W-S, Tam AR, Wu T-C, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. The Lancet Infectious Diseases. 2020; 20(5):565-574. DOI:

25. Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, et al. Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2. New England Journal of Medicine. 2020 [cited 2021/10/14]; 383(13):1283-1286. DOI:10.1056/NEJMc2016359.

26. McCormick-Baw C, Morgan K, Gaffney D, Cazares Y, Jaworski K, Byrd A, et al. Saliva as an Alternate Specimen Source for Detection of SARS-CoV-2 in Symptomatic Patients Using Cepheid Xpert Xpress SARS-CoV-2. Journal of Clinical Microbiology. 2020 [cited 2021/10/14]; 58(8):e01109-20. DOI:10.1128/JCM.01109-20.

27. Iwasaki S, Fujisawa S, Nakakubo S, Kamada K, Yamashita Y, Fukumoto T, et al. Comparison of SARS-CoV-2 detection in nasopharyngeal swab and saliva. Journal of Infection. 2020 [cited 2021/10/14]; 81(2):e145-e147. DOI:10.1016/j.jinf.2020.05.071.

28. Chen JH-K, Yip CC-Y, Poon RW-S, Chan K-H, Cheng VC-C, Hung IF-N, et al. Evaluating the use of posterior oropharyngeal saliva in a point-of-care assay for the detection of SARS-CoV-2. Emerging Microbes & Infections. 2020; 9(1):1356-1359. DOI:10.1080/22221751.2020.1775133.

29. Skolimowska K, Rayment M, Jones R, Madona P, Moore LSP, Randell P. Non-invasive saliva specimens for the diagnosis of COVID-19: caution in mild outpatient cohorts with low prevalence. Clinical Microbiology and Infection. 2020 [cited 2021/10/14]; 26(12):1711-1713. DOI:10.1016/j.cmi.2020.07.015.

30. Lai CKC, Chen Z, Lui G, Ling L, Li T, Wong MCS, et al. Prospective Study Comparing Deep Throat Saliva With Other Respiratory Tract Specimens in the Diagnosis of Novel Coronavirus Disease 2019. The Journal of Infectious Diseases. 2020 [cited 10/15/2021]; 222(10):1612-1619. DOI:10.1093/infdis/jiaa487.

31. Kim SE, Lee JY, Lee A, Kim S, Park K-H, Jung S-I, et al. Viral Load Kinetics of SARS-CoV-2 Infection in Saliva in Korean Patients: a Prospective Multi-center Comparative Study. jkms. 2020; 35(31):e287-0. DOI:10.3346/jkms.2020.35.e287.

32. Landry ML, Criscuolo J, Peaper DR. Challenges in use of saliva for detection of SARS CoV-2 RNA in symptomatic outpatients. Journal of Clinical Virology. 2020; 130:104567. DOI:

33. Becker D, Sandoval E, Amin A, De Hoff P, Diets A, Leonetti N, et al. Saliva is less sensitive than nasopharyngeal swabs for COVID-19 detection in the community setting. medRxiv. 2020:2020.05.11.20092338. DOI:10.1101/2020.05.11.20092338.

34. Yokota I, Shane PY, Okada K, Unoki Y, Yang Y, Inao T, et al. Mass Screening of Asymptomatic Persons for Severe Acute Respiratory Syndrome Coronavirus 2 Using Saliva. Clinical Infectious Diseases. 2021 [cited 10/15/2021]; 73(3):e559-e565. DOI:10.1093/cid/ciaa1388.

35. Zhu J, Guo J, Xu Y, Chen X. Viral dynamics of SARS-CoV-2 in saliva from infected patients. Journal of Infection. 2020 [cited 2021/10/14]; 81(3):e48-e50. DOI:10.1016/j.jinf.2020.06.059.

36. Byrne RL, Kay GA, Kontogianni K, Brown L, Collins AM, Cuevas LE, et al. Saliva offers a sensitive, specific and non-invasive alternative to upper respiratory swabs for SARS-CoV-2 diagnosis. medRxiv. 2020:2020.07.09.20149534. DOI:10.1101/2020.07.09.20149534.

37. Leung EC-m, Chow VC-y, Lee MK-p, Lai RW-m. Deep throat saliva as an alternative diagnostic specimen type for the detection of SARS-CoV-2. Journal of Medical Virology. 2021 [cited 2021/10/14]; 93(1):533-536. DOI:

38. Altawalah H, AlHuraish F, Alkandari WA, Ezzikouri S. Saliva specimens for detection of severe acute respiratory syndrome coronavirus 2 in Kuwait: A cross-sectional study. Journal of Clinical Virology. 2020; 132:104652. DOI:

39. Tsujimoto Y, Terada J, Kimura M, Moriya A, Motohashi A, Izumi S, et al. Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR. Infectious Diseases. 2021; 53(8):581-589. DOI:10.1080/23744235.2021




How to Cite

Suryani, D., Devi Rahmadhona, Prima Belia Fathana, Indah Sapta Wardani, Ika Nurfiria Tauhida, & Mohammad Rizki. (2022). Variation of Saliva Sampling Procedures in Detecting SARS-CoV2 with Real Time Polymerase Chain Reaction: A Scoping Review. Jurnal Kedokteran, 10(4), 682–693.



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