title: Patient Symptomatology in Anal Dysplasia.
abstract: OBJECTIVE
  High-resolution anoscopy (HRA) is becoming increasingly advocated as a method of screening for anal dysplasia in high-risk patients.
  
  
  OBJECTIVE
  To describe, through HRA findings, the association between patient symptomatology and anal dysplasia among patients at high risk for anal dysplasia.
  
  
  METHODS
  Univariable and multivariable analyses were conducted of data from a prospectively maintained HRA database on all patients undergoing HRA with biopsy from November 1, 2011, to March 13, 2014, at a tertiary care HRA clinic. Data included demographics, medical history and comorbidities, HIV status and related measures (CD4 cell counts, HIV viral load, and use of highly active antiretroviral therapy), sexual orientation (when available), patient symptoms at initial presentation, physical examination findings, anal Papanicolaou (Pap) smear findings.
  
  
  METHODS
  High-resolution anoscopy diagnosis of high- vs low-grade dysplasia or no dysplasia.
  
  
  RESULTS
  One hundred sixty-one HRA biopsy specimens (mean [SEM], 1.77 [0.11] biopsy specimens per patient) were obtained from 91 patients (mean [SEM] age, 45.7 [1.2] years; 61 men [67%]; 47 black patients [52%]; and 70 human immunodeficiency virus-positive patients [77%]). Twenty-seven patients (30%) had high-grade dysplasia, 26 had low-grade dysplasia (29%), and 38 had no dysplasia (42%). The majority of patients (63 [69%]) were asymptomatic (anal pain, 11 [12%]; bleeding, 14 [15%]; and pruritus, 10 [11%]). Forty-one patients (45%) presented with anal pain (odds ratio, 5.25; 95% CI, 1.44-21.82; P = .02), and patients with either high- or low-grade dysplasia were more likely to present with anal lesions on physical examination compared with patients without dysplasia (odds ratio, 4.34; 95% CI, 1.78-11.20; P = .002). Multivariable analysis suggested that anal pain was independently associated with high-grade dysplasia (odds ratio, 6.42; 95% CI, 1.18-43.3; P = .03).
  
  
  CONCLUSIONS
  Anal dysplasia is a silent disease that is frequently asymptomatic. However, patients with anal pain, anal lesions, and other high-risk factors are at increased risk of having high-grade anal dysplasia. These patients may benefit from routine screening with HRA.
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Caitlin W
authors: CW
authors: Hicks
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Elizabeth C
authors: EC
authors: Wick
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Ira L
authors: IL
authors: Leeds
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Jonathan E
authors: JE
authors: Efron
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Susan L
authors: SL
authors: Gearhart
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Bashar
authors: B
authors: Safar
authors: Division of Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Sandy H
authors: SH
authors: Fang
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D001004:Anus Diseases / Q000175:diagnosis* / Q000453:epidemiology; D058070:Asymptomatic Diseases; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult