Anal Pap Smear Tests in NYC

What is an Anal Pap Test?

Anal Pap smear (anal cytology) is a quick screening that collects cells from the lining of the anal canal to detect HPV‑related precancerous changes (dysplasia). In addition to detecting signs of anal cancer, anal pap smears help determine a patient’s risk for other potentially related anal issues. These findings can lead to discussing appropriate sexual history, examination, and fruitful conversations and/or solutions on the matter. Anal pap smear procedures are particularly encouraged for people with prostates who have sex with other people with prostates.

What to Expect During an Anal Pap Smear in NYC

The anal pap test consists of a cotton Q-tip swabbed internally in the anal canal for a few seconds. This is done twice, first to determine which specific HPV (Human Papillomavirus) strains one harbors (low or high risk specific to its subtypes) and then again for the actual precancerous/cancerous risk via extracting cells for analysis. Precancerous cells are also known as dysplastic cells.

The entire in-office visit typically takes about 20 minutes, while the swab itself takes less than a minute. You will lie on your side while the swab is gently rotated against the anal lining to collect the cells. You may feel a brief sensation of internal pressure or the urge to have a bowel movement during the swab, but it requires no anesthesia, and you can return to your normal routine immediately afterward.

Who Needs an Anal Cancer Screening?

Although there are no national guidelines for the general population in terms of who should be getting screened for anal cancers, there are some groups who are more at risk and can benefit from anal pap smears. This includes people living with HIV, according to an article from the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA) among others including:

• For People living with HIV. Screening is generally recommended starting around age 35.
• Men who have sex with men (MSM), particularly those with a history of receptive anal intercourse. Screening is generally recommended starting around age 40 to 45.
• Women who have receptive anal sex
• Women with a history of abnormal cervical Pap results. Screening is often recommended starting around age 45.
• All people infected with HIV who have genital warts (condylomas)
• Women who have had vaginal, vulvar, or cervical cancer
• Anyone who has had an organ transplant. Recommended starting around age 40 to 45.
• Anyone with a history of genital warts

Regardless of the categories above, anyone who actively bottoms should get screened annually. Age and risk-based guidelines are useful general benchmarks, but they shouldn’t replace regular screening for people who are sexually active as a receptive partner, whether or not they fall into one of the higher-risk groups above, and regardless of HIV status or prior test history.

How Often Should You Get an Anal Pap Smear Test?

For high-risk individuals, including men who have sex with men, people living with HIV, and anyone with a history of receptive anal intercourse or HPV – we recommend getting an anal pap smear once a year.

Your ongoing screening interval depends on your individual risk factors and test history:

• Normal Results (Negative): If your swab shows no abnormal cells or high-risk HPV strains, routine annual screening is generally recommended to monitor your baseline health.
• Abnormal Results (ASCUS, LSIL, or HSIL): If dysplastic cells or high-risk HPV are detected, you will need more frequent monitoring or follow-up High-Resolution Anoscopy (HRA), typically every 3 to 6 months until the tissue is clear.
• Post-Treatment Follow-Up: If you have received treatment for anal warts or high-grade dysplasia, regular checkups every 6 to 12 months ensure recurrent lesions are identified and managed early.

WHAT ARE THE POSSIBLE RESULTS OF AN ANAL PAP SMEAR TEST?

This leads us to the cellular findings. The anal pap smear examines the cells obtained from the swab test. Those cells constitute the outer layer of anal tissue, known as squamous cells, and indicate the level of infection that you may have. Positive anal pap smears are classified into 3 diagnostic categories: ASCUS, LGSIL, and HGSIL.

• Negative or Normal: There are no abnormal cells or signs of HPV-related changes.
• ASCUS: Atypical Squamous Cells of Unknown Significance is a diagnosis in which cells were found that were not normal, but also not identifiable. This can be caused by dysplasia, but it can also be caused by inflammation or other factors like hemorrhoids and fissures.
• LGSIL: Low Grade Squamous Intraepithilial Lesion, also known as mild dysplasia, is a diagnosis that can present with warts or lesions. It is not considered pre-cancerous, but can turn into HGSIL over time.
• HGSIL: High Grade Squamous Intraepithilial Lesion is a diagnosis in which there is precancerous change to the skin of the anal canal or perianal area. This is not cancer, and only a small fraction of these diagnoses progress into cancer.

With these results, one can risk stratify one’s propensity for internal cellular changes. The first pathway highlights some clear clinical changes during internal evaluation with visible evidence of pathology, such as anal wart lesions that justify the pap smear changes. The other is no visible clinical changes on internal anoscopic examination, but yet can be on the cellular level, one we cannot appreciate even on that level of visualization. This leads one down the path of a mapping procedure using high resolution anoscopy and chemicals to facilitate global biopsies and treatment.

CAN VACCINATIONS MITIGATE ANAL CANCER?

There is definitely a way we can test and isolate which subtypes of HPV one harbors. This not only allows us to stratify future risk of cancer risk when used in conjunction with the anal pap smear, but also can be utilized to assist in who would benefit from the HPV vaccination, Gardasil.

Though only paid for by the insurance companies for those under the age of 26, new data supports administering the HPV vaccine to those within the HIV positive community, as well as within the general population, specifically for men who have receptive anal sex with men, regardless of age. Though the cost may be high for most, it should be considered if one’s risk profile aligns.

Why Annual Anal Pap Smears Matter for Prevention

This field is still evolving and there are definitely some grey areas in management. There are still many people who don’t believe it and then, on the other hand, there are people who are fanatical about management. With every action, there is a reaction and we must be careful to weigh all risks and benefits associated with biopsies and their associated treatments. There is a fine balance between prevention and then rendering someone incapable of engaging in anal intercourse. One’s complete risk factors combined with the associated clinical testing needs to be taken into account with a formal discussion of all findings. This will lead a collaborative approach on the best preventative management possible with the least intrusive and invasive treatments.

We at Bespoke Surgical do believe in anal pap smears as part of a complete sexual evaluation of our clients and whole heartedly implore you to obtain one each year. It not only can save lives by preventing anal cancer, but also provides you with the most comprehensive sexual care geared towards the LGBTQ community.