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Considering surgical out-patient attenders with no history or signs of anal warts, 25% showed cytological evidence ofanal HPV infec-

The incidence of anal intraepithelial neoplasia (AIN) was studied in a group of 210 homosexual and bisexual men. The presence of genital warts and human immunodeficiency virus (HIV) infection was assessed as risk factors for the development of AIN. In all, 74 (35 per cent) of the group had histological evidence of AIN. The relative risk of being positive for HIV on AIN (relative to being negative for HIV) was 1.58 (95 per cent confidence interval (c.i.) 1.01-2.48). The relative risk of anal warts on AIN (relative to absence of anal warts) was 4.70 (95 per cent c.i. 1.81-12.20). Logistic regression analysis showed no significant interactive effect between HIV and anal warts on the risk of AIN. It is concluded from the results of a Mantel-Haenzel analysis that the presence of anal warts and HIV infection are independent risk factors for the development of AIN in homosexual and bisexual men.

The clinical and subclinical manifestations of anal human papillomavirus infection have been well reported in homosexual men.' Although anal warts have been reported to accompany genital warts in heterosexual men and women,23 the prevalence of subclinical anal human papillomavirus infection in heterosexual people has not been addressed previously. The mode of transmission of human papillomavirus to the anus is poorly understood and, although in some cases it may result from anal coitus,4 this fails to explain anal infection in heterosexual men.The aims of this study were to assess the prevalence of anal human papillomavirus infection in heterosexual men and women with genital warts and to examine whether anal infection is related to specific sexual behaviours. Subjects, methods, and resultsWe recruited heterosexual men and women attending the department of genitourinary medicine with newly diagnosed anogenital warts or warts untreated in the previous three months. Demographic