Anal Pap smear
An anal Pap smear is the anal counterpart of the cervical Pap smear.[1] It is used for the early detection of anal cancer. The Human papilloma virus (HPV), the cause of anogenital warts, can cause anal carcinomas to form.[2] Individuals with a history of anal warts are at risk of getting anal cancer.
Procedure
Typically, a small brush or cotton-tipped rod is inserted into the anus. The cells collected by the brush or rod are smeared onto a glass slide, air-dried, and sealed with an adhesive. Many medical offices prefer to suspend the collected cells in a liquid medium; the suspension is then plated on a glass slide. The suspended cells can also be used for HPV typing. The specimen is sent to a pathologist, indicating the source of the smear (anal canal).[3]
The procedure is easily performed in a doctor's office, using the same kit as for cervical cancer detection. It can be performed quickly, as a vaginal speculum or anoscope is not required.[4]
Indications
There is no consensus on who should get an anal Pap smear.[5] Some individuals recommend that all men and women who have anal sex should have an anal Pap smear performed regularly.[5] Some recommend it for all men who have had sex with men,[6] for all individuals with HIV and anal warts,[5] or for all individuals with a history of anal warts.[5] Cost-effectiveness modeling shows that anal Pap smears are cost-effective if performed in HIV-positive men with history of anal warts every year, and in HIV-negative men with history of anal warts every three years.[7]
An informal survey of local infectious-disease doctors in southeast Michigan suggested that few know where to send patients for an anal Pap smear. The procedure is very simple, and can be easily performed in any doctor's office with a little training.[4][8]
Treatment
A person might be referred to a colorectal surgeon, an infectious disease doctor, or a physician trained in colposcopy, examination, or biopsy of this region. At a minimum, a digital rectal exam is performed. A proctoscopic exam might follow. Ultimately, a biopsy might be performed, with or without the aid of a colposcope,[9] a dermatoscope, or a high resolution anoscopy.[9][10]
Bibliography
- Goldstone, S. (May-June 1999). "Anal dysplasia in men who have sex with men". The AIDS Reader 9 (3): 204–208, 220. PMID 12728907.
- Palefsky, Joel M.; Holly, Elizabeth A.; Ralston, Mary L. et al. (1998-04-01). "Anal Squamous Intraepithelial Lesions in HIV-Positive and HIV-Negative Homosexual and Bisexual Men: Prevalence and risk factors". Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology (Lippincott-Raven) 17 (4): 320–326. http://journals.lww.com/jaids/Fulltext/1998/04010/Anal_Squamous_Intraepithelial_Lesions_in.5.aspx. Retrieved 2011-06-01.
- Palefsky, Joel M.; Holly, Elizabeth A.; Hogeboom, Charissa J. et al. (1998-04-01). "Virologic, Immunologic, and Clinical Parameters in the Incidence and Progression of Anal Squamous Intraepithelial Lesions in HIV-Positive and HIV-Negative Homosexual Men". Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology (Lippincott-Raven) 17 (4): 314–319. http://journals.lww.com/jaids/Fulltext/1998/04010/Virologic,__Immunologic,_and_Clinical_Parameters.4.aspx. Retrieved 2011-06-01.
- Kiviat, NB; Critchlow, CW; Holmes, KK et al. (January 1993). "Association of anal dysplasia and human papillomavirus with immunosuppression and HIV infection among homosexual men". AIDS 7 (1): 43–49. doi:10.1097/00002030-199301000-00007. PMID 8382927.
- Goldie, Sue J.; Kuntz, Karen M.; Weinstein, Milton C. et al. (June 2000). "Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus–negative homosexual and bisexual men". The American Journal of Medicine 108 (8): 634–641. doi:10.1016/S0002-9343(00)00349-1. ISSN 0002-9343. PMID 10856411. http://www.amjmed.com/article/S0002-9343%2800%2900349-1/abstract.
- Goldie, Sue J.; Kuntz, Karen M.; Weinstein, Milton C. et al. (1999). "The Clinical Effectiveness and Cost-effectiveness of Screening for Anal Squamous Intraepithelial Lesions in Homosexual and Bisexual HIV-Positive Men". Journal of the American Medical Association (Chicago: American Medical Association) 281 (19): 1822–1829. doi:10.1001/jama.281.19.1822. http://jama.ama-assn.org/content/281/19/1822.full. Retrieved 2011-06-01.
References
- ^ Arain, Shehla; Walts, Ann E.; Thomas, Premi; Bose, Shikha (2005). "The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions". CytoJournal (Cytopathology Foundation) 2 (1): 4. doi:10.1186/1742-6413-2-4. ISSN 0974-5963. PMID 15715910. http://www.cytojournal.com/article.asp?issn=1742-6413;year=2005;volume=2;issue=1;spage=4;epage=4;aulast=Arain. Retrieved 2011-06-01.
- ^ "Anal cancer". aidsmap. London: NAM Publications. http://www.aidsmap.com/Anal-cancer/page/1044631/. Retrieved 2011-06-01.
- ^ "Anal Cancer Overview". Healthcommunities.com. Remedy Health Media. 2001-08-01. http://www.healthcommunities.com/anal-cancer/index.shtml. Retrieved 2011-06-01.
- ^ a b Daskalakis, Demetre. "The Anal Pap: a guide for primary care providers". hivcouncil.org. New Haven, CT: New Haven HIV Consumer Council. http://www.hivcouncil.org/AnalPap/Analpap_howto.html. Retrieved 2011-06-01.
- ^ a b c d Evans, David (2008-06-10). "Pap Smears for Anal Cancer?". AIDSmeds. New York: Smart + Strong. http://www.aidsmeds.com/articles/aids_anal_pap_2042_14727.shtml. Retrieved 2011-06-01.
- ^ Boskey, Elizabeth (2010-04-10). "The Anal Pap Smear: Who, When, & Why". About.com: Sexually Transmitted Diseases (STDs). New York: The New York Times Company. http://std.about.com/od/gettingtested/a/analpap.htm. Retrieved 2011-06-01.
- ^ Palefsky, Joel M.; Holly, Elizabeth A.; Ralston, Mary L.; Jay, Naomi (February 1998). "Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men.". The Journal of Infectious Diseases (The Infectious Diseases Society of America) 177 (2): 361–367. doi:10.1086/514194. ISSN 0022-1899. PMID 9466522. http://jid.oxfordjournals.org/content/177/2/361.full.pdf#page=1&view=FitH. Retrieved 2011-06-01.
- ^ "Human Papilloma Virus (HPV, genital warts, anal/cervical dysplasia/cancer". AIDSmeds. Smart + Strong. 2011-01-06. http://www.aidsmeds.com/articles/HPV_6806.shtml. Retrieved 2011-06-01.
- ^ a b Kesic, Vesna (2004). "Chapter 14: Colposcopy of the vulva, perineum, and anal canal". In Bősze, Péter; Luesley, David M.. EAGC Course Book on Colposcopy. European Academy of Gynaecological Cancer (EAGC). Primed-X Press. pp. 126–163. ISBN 9789630073561. http://www.gyncph.dk/procedur/ref/gyn/vulvoscopi_chapter14_eagc.pdf. Retrieved 2011-06-01.
- ^ http://www.gayhealth.com/templates/?explicit=off&record=249