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Tolerability of Anal Dysplasia Screening

Davis, Tony W. MD1; Goldstone, Stephen E. MD2; Chen, Guorong PhD3

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 404–408
doi: 10.1097/LGT.0b013e31827fb76c
Original Articles

Objective The incidence of anal human papillomavirus (HPV) infection and of HPV-related disease in men who have sex with men continues to rise. Screening procedures can be uncomfortable and may lead to decreased patient compliance. We endeavored to determine the tolerability of screening procedures for anal HPV disease.

Materials and Methods This was a 2-visit screening study. On visit 1 (V1), cells for cytology (using a swab) and HPV testing (randomized to a brush or swab) were collected, followed by digital rectal examination and standard anoscopy. At visit 2 (V2), patients had repeated HPV sampling (brush or swab) and high-resolution anoscopy with biopsy where indicated. Patients reported discomfort of procedures (0–5) and complications.

Results Visit 1 standard anoscopy caused the most discomfort (mean = 1.90). Visit 2 biopsy caused the least discomfort (mean = 1.04). The mean discomfort difference between V1 HPV sampling with swab (1.56) and brush (1.86) was significant (p = .03) but not at V2. The mean difference between V2 HPV brush (1.63) and V1 brush (1.86) discomfort was significant (p = .02), but there was no significant difference for V1 and V2 swab. There was no discomfort difference between standard anoscopy and high-resolution anoscopy (p = .14). All patients who reported at V1 that the discomfort would prevent them from having procedure again returned for V2. There was no significant difference in bleeding or pain after V1 for brush or swab.

Conclusions Screening procedures for anal HPV-related disease were well tolerated, and no single procedure or HPV sampling device reduced patient compliance.

An anal cancer screening study in New York City observed that procedures are well tolerated and do not reduce over the short-term patient compliance.

1Sackler School of Medicine, Tel Aviv, Israel; 2Department of Surgery, Mount Sinai School of Medicine, New York, NY; and 3Qiagen Gaithersburg, Inc., Gaithersburg, MD

Reprint requests to: Stephen E. Goldstone, MD, 420 West 23rd St, New York, NY 10011. E-mail:

Stephen E. Goldstone was supported by Qiagen Gaithersburg, Inc. for this research project through a grant. He is also a speaker for Qiagen Gaithersburg, Inc. Guorong Chen is an employee of Qiagen Gaithersburg, Inc. For the remaining authors, no conflicts were declared.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology