HPV & Anal Dysplasia
Anal dysplasia is a pre-cancerous condition which occurs when the mucosa lining of the anal canal undergo abnormal changes. During this condition, lesions or visible pattern of clustered abnormal cells appear. These cells may then progress from low-grade lesions to high-grade lesions.
Symptoms include genital and or anal warts in and around the anus. In some patients abnormalities in the lining of that anal region can occur without the presence of warts and any other symptoms.
Anal dysplasia is most commonly linked to Human Papilloma Virus (HPV) which is considered the most common sexually-transmitted infection. Roughly 80% of people who have had one or two lifetime sex partners and 100% of people who have had five lifetime sex partners have had HPV infection, thus HPV is extremely prevalent, particularly in young, sexually active populations. This original infection may resolve itself or may persist for life.
Anal cancer, like cervical cancer, is a member of a broader group of anogenital cancers known to be associated with sexually transmitted viral HPV infection. Anal cancer is rare in the general population but it is significantly more common in the HIV infected population, specifically in HIV-positive homosexual and bisexual men, where it presents at a rate of 70 per 100,000 men. Unfortunately, the risk for anal cancer is reported to be increasing dramatically in HIV-positive males and females, particularly since the introduction of highly active antiretroviral therapy in the mid-1990s. This is because people are living longer and some may continue to get newly exposed to other HPV viral strains.
Anal Dysplasia Screening
The purpose of the Anal Pap smear is to screen and prevent anal cancer, but it can identify other changes in the anus that may show pre-cancerous conditions. It is recommended that HIV positive patients, patients with history of genital or anal warts, previous anal dysplasia, and women with abnormal cervical pap smears have this procedure done once a year.
The procedure takes only one minute. Your provider will insert a moist Q-tip into your anus and remove it slowly in a circular motion. The procedure is essentially painless, and rarely associated with little discomfort. It does not require special bowel cleansing. The sample is then sent to the laboratory where it is read by a pathologist. Results are available in approximately three weeks.
This test is very sensitive and about one half of the results may be reported as other than “Normal”. You may have one of the following results:
- Normal – For HIV positive patients; repeat Pap smear in 1 year.
- Abnormal – with any of the following abnormal results, the patients in some situations should be referred for High Resolution Anoscopy (HRA).
- Atypical cells of undetermined significance (ASCUS): Means that there were mild cellular changes and the cause is unknown
- Low grade squamous intraepithelial lesion (LSIL): There are more noticeable changes in the cells that may indicate pre-cancerous conditions. You will be called by our office to schedule a more in depth examination or HRA.
- High grade squamous intraepithelial lesion (HSIL): There are more noticeable changes in the cells that may indicate pre-cancerous conditions. You will be called by our office to schedule a more in depth examination or HRA.
Normal. This is a normal test. As part of your medical care your provider may repeat the anal Pap every one or two years. You may not get a call from our office; however, the results will be discussed during your next scheduled appointment.
Unsatisfactory. The specimen is not adequate for evaluation by the laboratory. Your provider will repeat the anal Pap during your next scheduled visit.
ASCUS. (Atypical Cells of Undetermined Significance). Means that there were mild cellular changes and the cause is unknown. You will be called by our office to schedule a more in depth examination: High Resolution Anoscopy ( HRA ) and a possible biopsy.
Dysplasia. There are more noticeable changes in the cells that may indicate pre-cancerous conditions. You will be called by our office to schedule a more in depth examination: High Resolution Anoscopy ( HRA ) and a possible biopsy .
Anal Dysplasia Treatment
Anal Dysplasia can be treated successfully with very close follow up and monitoring. Individuals with low-grade lesions will generally have repeat HRA in 1 year. Individuals with high-grade lesions will have repeat HRA every 3-6 months. This will continue until there is no further evidence of high-grade dysplasia.
Infrared Coagulation (IRC)
IRC is a very simple and effective procedure to treat mild to moderate cases of anal dysplasia or warts of the anal canal.
The procedure takes place in our office and has minimal discomfort to you. This procedure is done using High Resolution Anoscopy only after the diagnosis of dysplasia and or warts have been confirmed.
Human Papilloma Virus (HPV)
HPV is a virus transmitted through contact with the skin and mucosal membranes found in the mouth, throat, vagina, cervix, anus and penis. There are over 100 HPV strains that can affect the human body. The vast majority of these viruses affect the skin and cause benign warts. About 40 HPV types are sexually transmitted and about 16 of those strains cause lesions that can progress to dysplasia and cancer. A person can be infected with multiple HPV strains simultaneously.
HPVs can be classified into high-risk and low-risk groups according to the likelihood that an infection by the HPV type can lead to a cancer. Most sexually active people will be infected with at least one type of HPV at some point in their lives. Having just one sex or oral sex partner can expose you to HPV. Although the immune system generally clears an HPV infection within several months to a few years, some infected people may not resolve the infection. The virus can remain in the skin layer and gradually alter cells so that they become abnormal and cancerous usually after a period of years or decades after the initial infection. If one has an HPV infection on their skin and experience a trauma such as a cut, the HPV can cause cell abnormalities deeper in the skin.
Men and women infected with HPV can unknowingly spread the virus as the infection may present no symptoms and infected individuals may not realize that they carry it. Though a condom may help reduce transmission, HPV is spread via skin-to-skin contact through the moist layer of skin and can therefore be passed onto a partner even when a condom is used. Nevertheless, safe sex practices including the use of condoms should still be utilized as a method to reduce the likelihood of transmission.
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