Cerejeira A, Cunha S, Coelho R, Macedo G, Barkoudah E, Azevedo F, Lisboa C
Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, EPE Porto, Porto, Portugal.
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
J Eur Acad Dermatol Venereol. 2020 Nov;34(11):2613-2619. doi: 10.1111/jdv.16834. Epub 2020 Aug 12.
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.
Our aim is to evaluate the role of perianal warts as a risk marker for anal high-risk (HR) HPV detection and anal dysplasia.
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).
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).
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.
尖锐湿疣是最常见的性传播感染（STI），由人乳头瘤病毒（HPV）引起。致癌基因型HPV的持续性肛门感染是肛门癌的一个决定因素。目前，肛门癌筛查尚未广泛实施。
我们的目的是评估肛周疣作为肛门高危（HR）HPV检测和肛门发育异常风险标志物的作用。
在这项对2010年1月至2018年6月期间性传播感染门诊就诊者进行的观察性、回顾性队列研究中，纳入了所有进行肛门细胞学检查、肛门HPV DNA检测和肛门镜检查的感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）。对有和没有肛周疣的患者进行了比较。主要终点：肛门细胞学异常患者的比例。次要终点：（i）检测到肛门HR-HPV的患者比例；（ii）检测到肛门HPV 16的患者比例；（iii）肛门活检异常的患者比例；以及（iv）肛门高级别鳞状上皮内病变（HSIL）的患者比例。
纳入了78名个体：39名有肛周疣，39名没有肛周疣。有肛周疣的受试者肛门细胞学异常更为常见（71.8%对38.5%；P = 0.003）。该组肛门HPV 16检测率也更高（38.5%对12.8%；P = 0.01）。在检测到肛门HR-HPV、肛门活检异常或肛门HSIL的患者比例方面未检测到差异。肛周疣是肛门细胞学异常（比值比：7.2）和肛门HPV 16检测（比值比：6.7）的独立危险因素。
鉴于HIV阳性MSM患肛门癌的风险很高，非常需要有效的筛查策略。这项研究表明，肛周疣的存在是检测肛门HPV 16和肛门发育异常的合适风险标志物。
