Akin to cervical cancer in sexually active women, men who have sex with men are predisposed to anal cancers especially with HIV co-infection. This cross-sectional study endeavored to assess the prevalence of anal dysplasia using Pap smears and p16 immunostaining amongst Indian men who have sex.

A total of 31 consecutive HIV-positive and 34 HIV-negative men who have sex, from a cohort of sexually transmitted infection clinic attendees, were subjected to anal cytological evaluation with Pap stain and p16 staining. Chi square test and coefficient of correlation were used for comparison.

Eighteen (27.7%) had abnormal anal cytology which was higher in HIV-positive as compared to HIV-negative group (35% versus 20%, p = 0.180). Similarly, both low-grade (25.8% versus 17.6%) and high-grade lesions (8.3% versus 4.8%) were comparable in HIV-positive and HIV-negative group. Thirteen (20%) smears were p16-positive with a sensitivity and specificity for anal dysplasia of 72.3% and 100%, respectively.

Anal cytology may be used to screen for anal dysplasia in men who have sex irrespective of HIV status. Furthermore, the addition of p16, with greater specificity for high-grade lesions, may improve diagnostic accuracy especially for high-grade lesions. A larger study to further corroborate these observations is recommended.