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Human Papillomavirus-Related Anal Precancerous Lesions in Men Who Have Sex With Men: A Comparative Study of

Magali Surmont1,2, Michel Verheyden3, Shaira Sahebali4

  • 1Department of Gastroenterology and Hepatology, UZ Brussel, Brussels, Belgium.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 5, 2026
PubMed
Abstract

Insights

Men who have sex with men using Pre-Exposure Prophylaxis (MSM-PrEP) may face anal high-grade squamous intraepithelial lesions (HSIL) risks similar to those with HIV. Tailored screening for anal cancer in MSM-PrEP is crucial.

Area of Science:

  • Oncology
  • Infectious Diseases
  • Public Health

Background:

  • Anal cancer disproportionately affects men who have sex with men (MSM) and people with HIV.
  • MSM using Pre-Exposure Prophylaxis (MSM-PrEP) are an emerging subgroup with potential risk factors for high-risk human papillomavirus (HR HPV) infection and anal HSIL.
  • Data on precancerous anal lesions in MSM-PrEP are currently limited.

Purpose of the Study:

  • To compare the prevalence and distribution of histological abnormalities via high-resolution anoscopy (HRA) between MSM-PrEP and MSM with HIV (HIV+MSM).
  • To explore the association between anal HSIL and anal swab results using cytology and HR HPV testing.

Main Methods:

  • Secondary exploratory analysis of a prospective, monocentric cross-sectional study.
  • Inclusion of histological data from 85 MSM-PrEP and 93 HIV+MSM.
  • Analysis of HRA findings, cytology, and HR HPV testing results.

Main Results:

  • No significant difference in histologically confirmed anal HSIL prevalence between MSM-PrEP and HIV+MSM (OR 0.6).
  • A history of gonorrhea was significantly associated with HSIL (OR 2.39).
  • HR HPV infection was detected in all HSIL cases, with many lesions linked to non-HPV16 types; cytology showed limited discriminatory value.

Conclusions:

  • MSM-PrEP may be at a similar risk for anal HSIL as HIV+MSM.
  • The findings highlight the need for tailored anal cancer screening strategies for MSM-PrEP.
  • Further research into HR HPV types and their role in anal lesions within this population is warranted.
Keywords:
HIVHPVMSMPrEPanal precancerous lesion

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