16. Prevalence and correlates of unsatisfactory anal pap tests (UAPT) in a community-recruited cohort of Australian homosexual men
Richard J. Hillman A , J. Roberts B , F. Jin C , I. M. Poynten D , A. Farnsworth B , C. Fairley D , S. Garland D , A. Grulich C , D. Templeton C and on behalf of the SPANC Study TeamA Western Sydney Sexual Health Centre, University of Sydney, Sydney, NSW, Australia.
B Douglass Hanly Moir, Sydney, NSW, Australia.
C Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
D University of Melbourne, Melbourne, Vic., Australia.
Sexual Health 10(6) 577-578 https://doi.org/10.1071/SHv10n6ab16
Published: 22 November 2013
Abstract
Background: Anal Pap tests have been advocated as a screening tool for anal precancerous lesions. We aimed to ascertain prevalence and correlates of UAPT among homosexual men. Methods: SPANC is a 3-year prospective study of homosexual men aged ≥35 years in Sydney. At baseline, data were collected and study procedures, including an anal swab for ThinPrep® cytology, were performed. Results: UAPT initially occurred in 40 (11.7%) of 342 participants (median age 49 years; 28.7% HIV positive) enrolled by the end of March 2013. There was no difference in UAPT by collecting clinician (P = 0.669) or reporting pathologist (P = 0.267). UAPT occurred more than twice as often among HIV-negative compared with -positive men (13.9% vs 6.1%, P = 0.048) and were less likely than satisfactory smears to contain transformation zone (TZ) cells (4.6% vs 35.4%, P < 0.001). Having a UAPT was associated with more anal Pap swab discomfort (P = 0.037) and feeling more tense during the exam (P = 0.008), but not with haemorrhoids or past anal surgery. On multivariate analysis, never douching (P < 0.001), soapy water douching (among those who douched; P = 0.003), fewer anal HPV types (P = 0.005) and feeling more tense during the exam (P = 0.039) remained independently associated with UAPT. All UAPT were repeated within a month and results were: 21 (52.5%) again unsatisfactory, 13 (32.5%) negative, 2 (5.0%) ASCUS/LSIL and 4 (10%) ASC-H/HSIL. Conclusions: UAPT are more common among men with less receptive anal sexual experience. Causes of UAPT may be a combination of sampling, behavioural and biological factors.
