Perianal warts as a risk marker for anal high‐risk‐human papillomavirus (HPV) detection and HPV‐associated diseases

Abstract

Background Genital warts are the most common sexually transmitted infection (STI) and are caused by human papillomavirus (HPV). Persistent anal infection by oncogenic genotypes of HPV is a determinant for anal cancer. Currently, anal cancer screening is not widely implemented. Objectives Our aim is to evaluate the role of perianal warts as a risk marker for anal high-risk (HR) HPV detection and anal dysplasia. Methods In this observational, retrospective, cohort study of attendees of a STI outpatient clinic between January 2010 and June 2018, all human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) who performed anal cytology, anal HPV DNA detection and anoscopy were included. A comparison was made between patients with and without perianal warts. Primary endpoint: proportion of patients with an abnormal anal cytology. Secondary endpoints: proportion of patients with (i) anal HR-HPV detection; (ii) anal HPV 16 detection; (iii) abnormal anal biopsy; and (iv) anal high-grade squamous intraepithelial lesion (HSIL). Results Seventy-eight individuals were included: 39 with perianal warts and 39 without perianal warts. Subjects with perianal warts more frequently had an abnormal anal cytology (71.8% vs. 38.5%; P = 0.003). This group also had a higher rate of anal HPV 16 detection (38.5% vs. 12.8%; P = 0.01). No differences were detected in the proportion of patients with anal HR-HPV detection, with an abnormal anal biopsy or with anal HSIL. Perianal warts was an independent risk factor for an abnormal anal cytology (OR: 7.2) and for anal HPV 16 detection (OR: 6.7). Conclusion Given the high risk of anal cancer in HIV-positive MSM, effective screening strategies are greatly needed. This study suggests that the presence of perianal warts is a suitable risk marker for anal HPV 16 detection and anal dysplasia.

Association between HPV infection and penile cancer and penile intraepithelial neoplasia: A retrospective observational study

“…16 Although associated with LR-HPV 6 and 11, genital warts could harbour HR-HPV as well as premalignant and malignant tumours. 9,17,18 As expected, we found that the presence or history of anogenital warts seems to be associated with positive HPV-DNA neoplasia.…”

Natural History of Anal Papillomavirus Infection in HIV-Negative Men Who Have Sex With Men Based on a Markov Model: A 5-Year Prospective Cohort Study

“…In China ( 9 ), the estimated prevalence of anal HPV among MSM was 85.1% (HIV-positive), 53.6% (HIV-negative), and 59.2% (unknown HIV status). Persistent infection with high-risk HPV (Hr-HPV) is a known cause of cervical, head and neck, penile and anal cancers ( 2 , 10 , 11 ), and low-risk HPV (Lr-HPV) can also cause genital warts ( 12 , 13 ). MSM are about 20 times more likely to develop anal cancer than heterosexual men are ( 14 , 15 ), and a recent study showed that HPV was detected in 88.3% of anal cancers ( 8 ).…”

Barriers and facilitators to anal cancer screening among people living with HIV in Puerto Rico

“…This finding suggests that physicians are probably recommending more of these procedures to PLWH with genital warts. Although genital warts are caused by low-risk HPV types, individuals with anal warts are at increased risk of anal cancer [ 31 – 33 ]. We also found that, unlike previously published findings [ 34 – 36 ], that fear, embarrassment, and cost were not common barriers reported by the participants in our study.…”