Follow-Up Recommendations for Anal HPV Infection

Risk Stratification for Follow-Up

The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) with HIV infection begin screening at age 35 with the highest risk (80-131 cases per 100,000 person-years) 1
The Centers for Disease Control and Prevention recommends that men with HIV infection begin screening at age 45 (40-60 cases per 100,000 person-years) 1
The Centers for Disease Control and Prevention recommends that women with HIV infection begin screening at age 45 (20-30 cases per 100,000 person-years) 1
The Centers for Disease Control and Prevention recommends that MSM without HIV infection begin screening at age 45 (14 cases per 100,000 person-years) 1

The Centers for Disease Control and Prevention recommends annual digital anorectal examination (DARE) for high-risk individuals, particularly persons with HIV infection and MSM without HIV with a history of receptive anal intercourse 1, 2
The Centers for Disease Control and Prevention states that DARE is acceptable to patients with low risk for adverse outcomes 1
The purpose of DARE is to detect masses on palpation that could indicate early anal cancer 1

The Centers for Disease Control and Prevention recommends referral to high-resolution anoscopy (HRA) for abnormal cytologic results (e.g., ASC-US, LSIL, or HSIL) 1, 2
The Centers for Disease Control and Prevention recommends HRA with biopsy for definitive diagnosis of high-grade squamous intraepithelial lesions (HSIL) 1
The Centers for Disease Control and Prevention recommends monitoring response to therapy and surveillance for evidence of progression using HRA 1

The Advisory Committee on Immunization Practices recommends HPV vaccination for all females aged 9-26 years and all males aged 9-21 years 3
The Advisory Committee on Immunization Practices recommends that males aged 22-26 years should also be vaccinated if not vaccinated at younger ages 3

The National Comprehensive Cancer Network recommends not assuming low risk despite negative initial screening; follow-up is still important for high-risk individuals 1, 4
The Centers for Disease Control and Prevention recommends not implementing cytology screening without access to HRA and biopsy services 1
The National Comprehensive Cancer Network recommends not delaying evaluation of abnormal screening results in high-risk individuals 4