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Anal Pap testing in gay men may cut STIs

Self-collection method almost as easy as peeing in a cup

TAKING CONTROL OF OUR HEALTH: Tom Lampinen's research suggests that routine self-collected anal Pap smear testing for gay men might prevent a significant percentage of sexually transmitted infections.

“It’s just another orifice,” Dr Thomas Lampinen says, describing the anus.

Lampinen is a clinical assistant professor in the Department of Health Care and Epidemiology at the University of British Columbia who recently published a study focussing on men collecting their own specimens for anal cancer screening.

Lampinen says “you could count on two hands” the number of cases of invasive anal cancer annually. But the rate of incidence is higher among men who have sex with men because it’s caused by a sexually transmitted virus, a strain of the Human Papilloma Virus (HPV). As a result, the medical community is beginning to explore the value of routine anal Pap tests for gay men.

Lampinen and his colleagues asked study participants to collect their own anal Pap smears, which required each subject to insert a swab into his anus to gather sample tissue cells. The swabs were then examined in the lab to detect any abnormalities that may indicate the presence of cancer or pre-cancerous cells. Researchers hoped to determine if self-collected samples would yield test results as accurate as those collected by doctors or nurses.

Lampinen and his colleagues have shown that, in a laboratory at least, men are able to collect samples that were adequate for cancer screening. He admits that, “it wasn’t quite as good as the nurse collecting it, but almost. With a little tweaking, we can improve that and make it just as good as a nurse or doctor collecting the specimen.

“The surprise was that the same self-collection technique could be used to screen for rectal gonorrhea and chlamydia,” he says. He suspects that would be useful in managing the rising rates of sexually transmitted infections (STIs) like syphilis, gonorrhea and chlamydia in gay men.

“We don’t think the infections are good things, and we also know they contribute to the spread of HIV, so it’s a really good idea to do some control,” he declares.

“If done on a wide scale, we would see in very short order, within one to two years, very large decreases in the rate of [transmission]. This new approach may represent a more successful way to expand regular screening of gay men for rectal infections because it puts the power for screening in men’s own hands without needing to see a doctor. That’s a very exciting prospect,” enthuses Lampinen.

He also says that men “felt less embarrassment and greater privacy [collecting Pap samples] on their own [rather] than when the nurse took it, [and] the level of pain that men reported [was] incredibly low.

“I don’t think men need to be squeamish. They just need to do it, and see that this [procedure] is really very simple,” he explains. “Everybody wasn’t [familiar], the first time they went into a laboratory to pee in a cup, but this is not much more complicated than that.”

He identifies two additional important benefits of this study. “The first [is] for research purposes. [We] can do studies with much larger numbers of men more cheaply and more rapidly if people can self-collect their own Pap smears.

“The second thing is that should Pap smears prove to be a worthwhile screening test, and we’re not there yet, then [it] would be a lot easier if men could collect their own because they wouldn’t have to go the doctor. They could collect one, put it in the mail [and] the laboratory or their doctor could notify them of any abnormality.

“Should we be introducing this new medical screening test as part of routine medical care?” he wonders.

“Most [sexually transmitted infections] of the urethra have symptoms of some kind and you might seek a doctor’s care,” he explains. “In the rectum, [however], about 80 percent of the time these infections are without any symptoms at all.” Even through there are no symptoms, the infections can still be passed on to other sex partners.

“The only solution, then, is to be screening men who are without symptoms by doing rectal testing,” he explains. “While doctors could be doing this–and in the United States there are strong recommendations to screen sexually active gay men regularly for rectal STIs–that screening just doesn’t go on very frequently,” he laments.

Lampinen says routine Pap testing might also help to decrease HIV prevalence.

“If you’re a person who’s HIV-negative and you have syphilis or gonorrhea, your risk for acquiring HIV goes up because of the presence of these other infections,” he says.

“If you have HIV, the presence of these infections makes you more likely to transmit HIV to your sexual partners.

“These infections can cause breaks in the genital skin and that’s where the contact and the transfer of the virus occurs. [They also draw] immune cells to the site of the infection, and those are the very cells that either carry HIV in an HIV-positive guy, or are susceptible to HIV infection in an HIV-negative guy. The more of these cells you have on the genital surface, the greater your odds for transmitting and acquiring HIV. From an HIV prevention standpoint, the treatment of these other infections in gay men is an essential component.”