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A Pilot Study of the Prevalence of Anal Human Papillomavirus and Dysplasia in a Cohort of Patients With IBD

Cranston, Ross D., M.D., F.R.C.P.1; Regueiro, Miguel, M.D.2; Hashash, Jana, M.D.2; Baker, Jonathan R., P.A-C.3; Richardson-Harman, Nicola, Ph.D.4; Janocko, Laura, Ph.D.5; McGowan, Ian, M.D., Ph.D., F.R.C.P.2,5

doi: 10.1097/DCR.0000000000000878
Original Contributions: Inflammatory Bowel Disease
Denotes Associated Video Abstract
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BACKGROUND: Defective cell-mediated immunity increases the risk of human papillomavirus–associated anal dysplasia and cancer. There is limited information on anal canal disease in patients with IBD.

OBJECTIVE: The purpose of this study was to assess anal/vaginal human papillomavirus and anal dysplasia prevalence in patients with IBD.

DESIGN: Patients had an anal examination before routine colonoscopy.

SETTINGS: The study was conducted at a tertiary IBD referral center.

PATIENTS: We studied a convenience sample of sexually active male and female patients with IBD who were not on biological therapy.

INTERVENTION: Anal examination, anal and vaginal human papillomavirus testing, anal cytology, and high-resolution anoscopy/biopsy were carried out.

MAIN OUTCOME MEASURES: Anal and vaginal human papillomavirus types, anal cytology, and biopsy grade were measured.

RESULTS: Twenty-five male and 21 female evaluable participants, 31 with Crohn’s disease, 14 with ulcerative colitis, and 1 with indeterminate colitis, were predominantly white (91.3%), treatment experienced (76.1%), an average age of 38.1 years (range, 22.0–66.0 y), and had an average length of IBD diagnosis of 9.3 years (range, 1.0–33.0 y). Eighteen (39.1%) had an abnormal perianal examination and 3 (6.5%) had an abnormal digital examination. Forty-one (89.1%) had anal human papillomavirus, 16 with a single type and 25 with multiple types (range, 2–5 types). Human papillomavirus type 16 was most common (65.2%), followed by human papillomavirus types 11 and 45 (37.0% each). Nineteen of 21 (90.5%) women had vaginal human papillomavirus. Overall, 21 (45.7%) had abnormal anal cytology. Thirty three (71.7%) had ≥1 anal biopsy (9 had multiple), with dysplasia diagnosed in 28 (60.9%) and high-grade and low-grade squamous intraepithelial lesions diagnosed in 4 (8.7%) and 24 (43.5%).

LIMITATIONS: No control group was included, and no detailed sexual history was taken.

CONCLUSIONS: A high prevalence of anal and vaginal human papillomavirus and anal dysplasia was demonstrated in the study population outcomes. See Video Abstract at

1 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

2 Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

3 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

4 Alpha StatConsult, Damascus, Maryland

5 Magee–Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania

Funding/Support: This work was supported by a research grant through the Merck Investigator Studies Program of Merck and Co.

Financial Disclosure: Dr Cranston receives royalties from UpToDate medical encyclopedia; Dr McGowan is a board member of Novicol Life Sciences and a consultant for ABIVAX and Aelix Therapeutics consultancy; and Dr Regueiro is a consultant for Shire, Abbvie, Takeda, and UCB.

Poster presentation of incomplete data at Digestive Disease Week, Orlando, Florida, May 18 to 21, 2013.

Correspondence: Ross D. Cranston, M.D., F.R.C.P., Fundació Lluita Contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons