HPV infection and intraepithelial lesions from the anal region: how to diagnose?

Abstract

In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy. Keywords: anal canal; papillomavirus infections; cell biology; carcinoma in situ.identify these pre-invasive lesions is being questioned. Such questions relate to the groups to be screened and the best way to implement it such screening. The purpose of this study was to review the literature about the use of anal cytology and anoscopy to screening and evaluation of anal intraepithelial neoplasia. ANAL CYTOLOGYAnal cytology is a noninvasive method of screening, which is performed primarily by anal secretion collection through a brush (Dacron swab) introduced into the anal canal and removed with gentle rotation movements. It is indicated to avoid anal sex and douching in the day before the procedure, since these practices can decrease cellular recovery. Special caution should be taken for not touching anal canal warts and rectum walls with the brush to avoid any fecal contamination.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo papilomavírus humano (HPV)

“…21 En la presencia de lesiones anales, lo ideal sería la realización de un examen proctológico con anoscopia y toque rectal, o aún, con anoscopia de alta resolución. 22 El estudio citológico de material recolectado del canal anal todavía no tiene indicación de forma sistemática; no obstante, puede ser indicado en poblaciones especiales (hombres que tienen sexo con hombres, personas con práctica sexual anal receptiva y personas con cáncer o lesiones de alto grado), en razón de aumento de la incidencia de cáncer anorrectal. 23 No se recomiendan las pruebas para el tipado de PVH en la rutina clínica o en rastreo de personas asintomáticas, especialmente en adolescentes, debido a la alta prevalencia de infección por el PVH en ese grupo de edad.…”

Brazilian Protocol for Sexually Transmitted Infections 2020: human papillomavirus (HPV) infection

“…In the presence of anal lesions, a proctological examination with anoscopy and rectal touch, and even high-resolution anoscopy, would be ideal 22 . The cytological study of material collected from the anal canal is not yet indicated systematically; however, it may be indicated in special populations (men who have sex with men, people with receptive anal intercourse, and people with cancer or highgrade lesions) due to the increased incidence of anorectal cancer 23 .…”

Anal High-risk HPV and Liquid-based Cytology of Immunocompetent Brazilian Women with Genital High-risk HPV

“…10 Women with a history of a genital squamous intraepithelial lesion (SIL) are at increased risk for anal HSILs and cancer as compared with the general population, and some authors recommend anal cytological screening for these women. [10][11][12][13] In Brazilian women, there are few studies on the prevalence of anal Hr-HPV and anal SILs. The purpose of this study was to evaluate the frequency of Hr-HPV infection and abnormal anal liquid-based cytology among immunocompetent women with and without a genital SIL.…”

“… 10 Women with a history of a genital squamous intraepithelial lesion (SIL) are at increased risk for anal HSILs and cancer as compared with the general population, and some authors recommend anal cytological screening for these women. 10 11 12 13 …”