Anal Pap smear

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Anal Pap smear
ICD-9: 90.96

An anal Pap smear is the anal counterpart of the cervical Pap smear.[1] It is used for the early detection of anal cancer. Some types of human papillomavirus (HPV) can cause anal cancer.[2] Other HPV types cause anogenital warts. Individuals with a history of anal warts are at increased risk of getting anal cancer.[citation needed] Vaccination against HPV before initial sexual exposure can reduce the risk of anal cancer.

Indications [edit]

There is no consensus on who should get an anal Pap smear.[3] Some individuals recommend that all men and women who have anal sex should have an anal Pap smear performed regularly.[3] Some recommend it for all men who have had sex with men,[4] for all individuals with HIV and anal warts,[3] or for all individuals with a history of anal warts.[3] Cost-effectiveness modeling shows that anal Pap smears are cost-effective if performed in HIV-positive men with history of anal warts every year, and in HIV-negative men with history of anal warts every three years.[5]

An informal survey of local infectious-disease doctors in southeast Michigan suggested that few know where to send patients for an anal Pap smear. The procedure is very simple, and can be easily performed in any doctor's office with a little training.[6][7]


Typically, a small brush or cotton-tipped rod is inserted into the anus. The cells collected by the brush or rod are smeared onto a glass slide, air-dried, and sealed with an adhesive. Many medical offices prefer to suspend the collected cells in a liquid medium; the suspension is then plated on a glass slide. The specimen is sent to a pathologist, indicating the source of the smear (anal canal). The suspended cells can also be used for HPV typing.[8]

The procedure is easily performed in a doctor's office, using the same kit as for cervical cancer detection. It can be performed quickly, as a vaginal speculum or anoscope is not required.[6]

Treatment [edit]

A person might be referred to a colorectal surgeon, an infectious disease doctor, or a physician trained in colposcopy, examination, or biopsy of this region. At a minimum, a digital rectal exam is performed. A proctoscopic exam might follow. Ultimately, a biopsy might be performed, with or without the aid of a colposcope,[9] a dermatoscope, or a high resolution anoscopy.[9][10]

Bibliography [edit]


  1. ^ Arain, Shehla; Walts, Ann E.; Thomas, Premi; Bose, Shikha (2005). "The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions". CytoJournal (Cytopathology Foundation) 2 (1): 4. doi:10.1186/1742-6413-2-4. ISSN 0974-5963. PMID 15715910. Archived from the original on 8 July 2011. Retrieved 2011-06-01. 
  2. ^ "Anal cancer". aidsmap. London: NAM Publications. Archived from the original on 5 June 2011. Retrieved 2011-06-01. 
  3. ^ a b c d Evans, David (2008-06-10). "Pap Smears for Anal Cancer?". AIDSmeds. New York: Smart + Strong. Archived from the original on 7 July 2011. Retrieved 2011-06-01. 
  4. ^ Boskey, Elizabeth (2010-04-10). "The Anal Pap Smear: Who, When, & Why". Sexually Transmitted Diseases (STDs). New York: The New York Times Company. Archived from the original on 7 July 2011. Retrieved 2011-06-01. 
  5. ^ Palefsky, Joel M.; Holly, Elizabeth A.; Ralston, Mary L.; Jay, Naomi (February 1998). "Prevalence and risk factors for human papillomavirus infection of the anal canal in human immunodeficiency virus (HIV)-positive and HIV-negative homosexual men.". The Journal of Infectious Diseases (PDF) (The Infectious Diseases Society of America) 177 (2): 361–367. doi:10.1086/514194. ISSN 0022-1899. PMID 9466522. Retrieved 2011-06-01. 
  6. ^ a b Daskalakis, Demetre. "The Anal Pap: a guide for primary care providers". New Haven, CT: New Haven HIV Consumer Council. Retrieved 2011-06-01. 
  7. ^ "Human Papilloma Virus (HPV, genital warts, anal/cervical dysplasia/cancer". AIDSmeds. Smart + Strong. 2011-01-06. Retrieved 2011-06-01. 
  8. ^ "Anal Cancer Overview". Remedy Health Media. 2001-08-01. Retrieved 2011-06-01. 
  9. ^ a b Kesic, Vesna (2004). "Chapter 14: Colposcopy of the vulva, perineum, and anal canal". In Bősze, Péter; Luesley, David M. EAGC Course Book on Colposcopy. European Academy of Gynaecological Cancer (EAGC). Primed-X Press. pp. 126–163. ISBN 978-963-00-7356-1. Retrieved 2011-06-01. 
  10. ^[dead link]