Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic.
BACKGROUND
The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology.


OBJECTIVE
This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears.


METHODS
We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coefficient of correlation were used for comparison.


RESULTS
Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia.


CONCLUSIONS
The limitations included a small sample size, lack of correlation with histological findings and bias due to STI clinic-based recruitment of the study population.


CONCLUSIONS
Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.
Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India.
Kavita
K
Bisherwal
Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India.
Deepika
D
Pandhi
Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India.
Archana
A
Singal
Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India.
Kiran
K
Guleria
Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India.
Kiran
K
Mishra
D000328:Adult; D000554:Ambulatory Care Facilities; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010865:Pilot Projects; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology