Dear Dr. D,

I would like to find out if it is possible do have an anal pap smear in Cape Town… as it is important to diagnose anal cancer early with this pap smear.

Anonymous, Cape Town

Dear Anonymous,
 
This is actually a good question.  Sexually active gay man are at an increased risk of acquiring infection from the human papillomavirus (HPV), a rather hardy virus that can lead to abnormal rectal cells of the anus and, in small a number cases, to anal cancer. 
 
As background, HPV is a virus infects the epidermis and mucous membranes. Approximately 130 types of HPV types have been identified, some of which can cause warts, but don’t cause cancer. Alternately, others can cause cancer, but don't cause warts. Others have no symptoms at all and are completely.

It's important to note that the vast majority of those who contract HPV don't get anal cancer.  It's just one of those associated factors we watch for when assessing your risk for anal cancer.  Other risk factors include: number of lifetime sexual partners, genital warts, pre-existing fistulas (abnormal openings in the anus), HIV, and men over the age of 50.

Today, HPV is most common sexually transmitted infection in the U.S, with most sexually active men and women (75-80%) likely to acquire genital HPV infection at some point in their lives. It was estimated that in 2000 there were approximately 6.2 million new HPV infections among Americans aged 15–44. (No data is available in South Africa.) 

In the medical community, there has thus far been no consensus on who should get an anal pap smear. Some have suggested that they should be performed regularly for all men and women who every have had anal sex. This is likely excessive. Others recommend it for men who have sex with men (MSM), or for anyone with HIV who has had anal warts.

An informal survey in the U.S. has shown that anal pap smears are most effective if performed in HIV-positive men with history of anal warts every year, and in HIV-negative men with history of anal warts every three years.
 
The test itself is a very simple test.  Your primary care doctor should be able to do this, whereby he simply inserts a special swab into your anus to obtain cells.  The cells will be transferred to a slide and prepared for the lab.  That's all there is to it.  (Please note, however, that anal pap smears to do not screen for prostate or colon diseases. You will still need to have both these tests done regularly.)

If the test comes back positive, IT DOES NOT MEAN THAT YOU HAVE OR WILL EVER GET CANCER. But it does require follow-up investigation, usually with a digital rectal exam at the very least, followed by a proctoscopic examination, if indicated.
 
So contact your primary care doctor and ask for the test.  It's a good monitoring exam and something we as treaters should consider integrating into our HIV practices.
 
Best regards,
Dr. D