Metrics details. Factors associated with anogenital disease were assessed by logistic regression models. No cases had HSIL or cancer. In this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population. Anogenital human papillomavirus HPV is the most frequent sexually transmitted infection STI in the world, in both men and women [ 1 , 2 ].
Anogenital HPV is classified into high-risk HR types, that are implicated in men in the evolution of anal and penile cancers, and low-risk LR types which are largely associated with the development of anogenital warts AGWs [ 4 ].
While AGWs are benign, they are a source of psychosocial distress [ 11 ] and can cause physical discomfort, including bleeding and itching [ 12 ]. The incidence of anogenital HR-HPV infection in men in South Africa is also concerning, averaging 40 per person-years [ 20 , 21 , 22 ].
This is in part attributed to immune dysfunction which impairs immuno-surveillance and clearance of viral infections such as HPV [ 24 , 28 ]. While data suggest that the progression of AIN disease is less predictable than cervical cancer with some AIN lesions spontaneously regressing, [ 6 ] ART does not appear to reverse the risk for anal cancer once AIN is identified [ 29 ].
A number of strategies have been proposed to reduce anogenital HPV infection and its associated burden of disease in men. Screening for AIN using anal cytology has been recommended in some high-income countries [ 30 ].
