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Anal Pap Smears, HPV and Anal Cancer

The prevalence of anal cancer in gay men, particularly in HIV positive men, is much higher than in heterosexual men[2] [1] [4].

 cervical cancer in women

 8/100 000

 anal cancer in straight men

 0.8/100 000

 anal cancer in HIV - gay men

 35/100 000

 anal cancer in HIV + gay men

 70/100 000

Risk factors for anal cancer:

  • smoking

  • receptive anal intercourse

  • genital warts

  • Herpes Simplex Virus Type 2

  • Hepatitis B

  • Chlamydia

  • HIV

HPV has similar carcinogenic effects on the anus as it does on the cervix. Anal cancer is preceded by detectable premalignant changes in the anal mucosa and is related to specific HPV infections. Similar to cervical Pap smears, checking for pre-malignant lesions of the cervix, it is recommended that anal cytological screening be performed every three years for all individuals (men and women) who engage in receptive anal intercourse, and every year for HIV positive individuals who engage in receptive anal intercourse[1] [4].

Directions for performing an anal Pap smear:

  • position the patient as for a digital rectal exam with anal exposure (do the pap smear before a digital rectal exam)

  • visually examine the anus and surrounding area for active lesions

  • spread the buttocks with one hand in order to visualize the anoderm

  • insert a Dacron swab or cytobrush into the anus 1 or 2 inches and rotate the brush 360° several times while moving it in and out

  • roll the brush onto a microscope slide and apply cytological fixative

  • Remember to label the sample as coming from the anus.

If HPV or dysplasia is detected, follow-up with anal colposcopy is indicated. [2] [1]


1. Peterkin A, Risdon C. Caring for Lesbian and Gay People: A Clinical Guide. 2003. University of Toronto Press Incorporated. Toronto, Ontario.

2. Kaiser Permanente National Diversity Council. A Provider's Handbook on Culturally Competent Care: Lesbian, Gay, Bisexual and Transgendered Population. Oakland, CA. Kaiser Permanente; 2000.

4. Anonymous [Council on Scientific Affairs, American Medical Association]. Health care needs of gay men and lesbians in the United States. Journal of the American Medical Association. 1996;275(17):1354-1359.

All references for this section