Histological outcomes of anal high-grade cytopredictions.

BACKGROUND: Longitudinal studies of histological outcomes after anal cytological screening in men who have sex with men (MSM) are rare. This study measured the positive predictive values (PPVs) of each level of baseline cytological abnormality in MSM in Sydney, Australia, over a 12-month period. METHODS: The Study of the Prevention of Anal Cancer is a 3-year prospective study of the natural history of anal human papillomavirus infection in MSM at least 35 years old. For each participant with a baseline cytological abnormality, the worst histology was recorded at the baseline high-resolution anoscopy and at 6 and 12 months. PPVs for a histological high-grade squamous intraepithelial lesion (HSIL) diagnosis were calculated for each level of baseline cytological abnormality at each time point. RESULTS: Among 424 men who completed 3 visits, the PPV of a cytological HSIL increased from 71.6% at the baseline to 86.4% at 6 months and to 92.6% at 12 months (P < .001). For cytological atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H), the PPV increased from 51.5% at the baseline to 69.7% at 6 months and to 75.8% at 12 months (P = .004). At each time point, the PPV of a cytological HSIL was significantly higher than the PPV of ASC-H. The PPV of low-grade cytology reports was significantly lower than the PPV of ASC-H at each time point. CONCLUSIONS: In a cohort of MSM, a baseline histological HSIL diagnosis after an HSIL cytoprediction is high, and it increases with further examinations over the course of 12 months. Lower levels of cytological abnormalities have significantly lower PPVs. These data can inform patient management and the quality assessment of each aspect of the screening pathway. Cancer Cytopathol 2018;126:136-44. © 2017 American Cancer Society.

Increasing yield of pharyngeal Chlamydia trachomatis among male gay and bisexual clinic attendees in Sydney: an observational study.

Background The aim of the present study was to describe the temporal trends in Chlamydia trachomatis (CT) testing yield among gay and bisexual male (GBM) sexual health clinic attendees in Sydney. METHODS: All CT testing occasions among GBM from January 2011 to December 2014 were reviewed. Yield was defined as the proportion of testing occasions where CT was detected. RESULTS: In all, 2917 GBM were tested on 5445 occasions. CT was detected on 439 (8.1%; 95% confidence interval (CI) 7.4-8.8%) occasions. Pharyngeal, urethral and anorectal CT were detected on 74 (1.4%; 95% CI 1.1-1.7%), 109 (2.0%; 95% CI 1.7-2.4%) and 333 (6.1%; 95% CI 5.5-6.8%) occasions respectively. Over the study period, there was a significant increase in pharyngeal CT yield (from 0.70% to 1.6%; odds ratio (OR) 1.25; 95% CI 1.01-1.55; Ptrend=0.043), which remained borderline significant (OR 1.22; 95% CI 0.99-1.52; P=0.067) when adjusted for age. There was no change in yield of either urethral or anorectal infections. Almost half the pharyngeal CT (n=35; 47.3%) occurred without concurrent anogenital infection. Excluding those who would have received anti-chlamydial treatment for another reason, 27.0% of pharyngeal and 4.6% of all CT infections would not have been treated without pharyngeal testing. CONCLUSIONS: A recent temporal increase was observed in the yield of pharyngeal CT without a concurrent increase in anogenital yield. Ongoing surveillance is warranted to inform testing guidelines for GBM.