Clearance of Anal HPV in Men Who Have Sex with Men

Natural History of Anal HPV Infection in MSM

The Centers for Disease Control and Prevention (CDC) notes that HPV is associated with approximately 90% of anal squamous cell cancers, with men who have sex with men (MSM) having a significantly higher risk of HPV infection and HPV-related disease compared to heterosexual men 1, 2
The incidence of anal neoplasia is nearly 20 times higher in MSM than in the general population, with annual recurrence rates of high-grade anal lesions following treatment reaching up to 50% 3
Most HPV infections are asymptomatic and clear spontaneously without causing health problems, though some progress to genital warts, precancers, and cancers, as reported by the American Cancer Society 4

The European Centre for Disease Prevention and Control recommends HPV vaccination for MSM aged 9-26 years due to high incidence and low clearance rates of anal HPV 3
The quadrivalent HPV vaccine has shown efficacy in preventing 77.5% of high-grade squamous intraepithelial lesions/anal intraepithelial neoplasia secondary to HPV 6, 11, 16, or 18, and 70.2% of genital warts in MSM, according to the World Health Organization 3
In MSM aged 26 years and older, the quadrivalent vaccine has demonstrated effectiveness in preventing anal condyloma and reducing the incidence of high-grade squamous intraepithelial lesions, as stated by the European Centre for Disease Prevention and Control 5

The American College of Physicians notes that no national recommendations exist for cytologic screening to prevent anal cancers, despite the high risk in MSM 1
The Infectious Diseases Society of America states that data are insufficient to recommend routine anal cancer screening with anal cytology in HIV-negative MSM, though an annual digital anorectal examination may be useful for early detection of anal cancer 6
The National Institutes of Health recognizes anal intraepithelial neoplasia (AIN) as a precursor of anal cancer, although the natural history of these lesions is less clear than for cervical intraepithelial neoplasia, as reported by the Centers for Disease Control and Prevention 1
Treatment options for anal HPV-related lesions include various local approaches that remove the lesion, such as cryotherapy, electrocautery, laser therapy, and surgical excision, as recommended by the American Society for Colposcopy and Cervical Pathology 1, 7