Front-to-back & dabbing wiping behaviour post-toilet associated with anal neoplasia & HR-HPV carriage in women with previous HPV-mediated gynaecological neoplasia.
Anal cancer is a human papillomavirus (HPV)-mediated neoplasia of the anal squamous epithelium. Anal cancer is much more common among women, particularly those with a previous high-grade gynaecological neoplasia.



Cross-sectional study of women with a previous HPV-mediated gynaecological neoplasia in Tasmania, Australia. Women presenting for follow-up gynaecological care had anal swab samples taken for anal cytology by Hologic Liquid ThinPrep, followed by HPV genotyping. Women with abnormal anal cytology were invited for high-resolution anoscopy. Potential risk factors, including post-toilet wiping behaviours, were queried by questionnaire while clinical covariates were extracted from medical records. Covariates of anal outcomes evaluated by log-binomial and log-multinomial regression.



From 163 women enrolled in the study, 65 (39.9%) had abnormal cytology, with 46 (28.2%) being high-grade. Of the 50 women with abnormal anal cytology having high-resolution anoscopy, 32 (64.0%) had abnormal histology with 13 (26.0%) being high-grade. Of the 123 women tested for HR-HPV DNA, 48 (39.0%) had HR-HPV detected, the most common genotypes being 16 and 51 (14/123, 11.4% for both). In addition to some known anal cancer risk factors, we found front-to-back wiping was associated with significantly increased (Prevalence ratio (PR) range: 1.99-3.60) prevalence of cytological and histological abnormality and HR-HPV carriage/co-carriage, while dabbing post-toilet was significantly associated with decreased prevalences (PR range: 0.50-0.62).



Post-toilet wiping behaviours were significantly associated with the prevalence of anal cytological, histological and HR-HPV carriage outcomes. This suggests a biologically plausible mechanism for HR-HPV introduction and the higher frequencies of anal neoplasia in women.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: steve.simpson@utas.edu.au.
Steve
S
Simpson
Gynaecologic Oncology, Royal Hobart Hospital, Hobart, Australia; School of Medicine, University of Tasmania, Hobart, Australia.
Penny
P
Blomfield
Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia.
Alyssa
A
Cornall
Regional HPV Labnet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.
Sepehr N
SN
Tabrizi
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Leigh
L
Blizzard
School of Medicine, University of Tasmania, Hobart, Australia.
Richard
R
Turner
D000328:Adult; D001003:Anal Canal / Q000821:virology*; D001005:Anus Neoplasms / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D006920:Hygiene; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000821:virology*; D012307:Risk Factors
Anal neoplasia; Epidemiology; Human papillomavirus; Perineal hygiene; Post-toilet wiping; Women