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Screening for anal warts (Anal PAP smears)
Aug 3, 2001

What are the current recommendations for anal pap smears in HIV positive men and women?

Response from Dr. Dezube

Excellent question. There are NO official guidelines regarding anal PAP smears. (A PAP smear is a test by which a health care provider checks a patient's cervix and/or anus for cells which are precancerous or cancerous). The following is one approach used by many experts in the field. Again this is just an approach. The specifics will depend upon the expertise of your local facility, your specific situation, and so on.

1) HIV negative men with history of receptive anal intercourse (i.e. "bottoms") or anal warts. If the first anal PAP is negative, it should be repeated in 6 months. If the second PAP is negative, then repeat PAP should be obtained in 3 to 5 years.

2) HIV positive men with history of anal intercourse. If the first anal PAP is negative, it should be repeated in 6 months. If the second PAP is negative, then repeat PAP smear should be obtained in one year. Some clinicians screen patients with CD4 counts <200 more frequently.

3)HIV positive women with history of anal warts, high grade cervical pre-cancer (CSIL), or invasive cervical cancer. If the first anal PAP is negative, it should be repeated in 6 months. If the second PAP is negative, then repeat PAP smear should be obtained in one year. Some clinicians screen patients with CD4 counts <200 more frequently.


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