{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:12:07Z","timestamp":1790140327143,"version":"4.0.1"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:p>Anal cytology has been suggested as a screening test for the anal cancer precursor high-grade squamous intraepithelial lesion (HSIL). We aimed to assess the prevalence and predictors of initial unsatisfactory anal cytology tests (\u2018unsats\u2019). The Study of the Prevention of Anal Cancer is a natural history study of anal human papillomavirus (HPV) and precancerous lesions among gay and bisexual men (GBM) of at least 35 years in Sydney, Australia. At each study visit, an anal swab is collected for cytological testing. Unsats are defined as slides with fewer than 2000 nucleated squamous cells and no abnormal cells. Among 617 GBM enrolled, the median age was 49 (range: 35\u201379) years and 220 (35.7%) were HIV positive. Initial unsats occurred in 61 (9.9%, 95% confidence interval: 7.6\u201312.5%), and 29 (4.7%, 95% confidence interval: 3.2\u20136.7%) remained unsatisfactory on repeat cytology. Initial unsats were associated with fewer lifetime anal-receptive partners with a condom (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.007); fewer recent anal-receptive sexual partners without a condom (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.005); never having had anal chlamydia (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.023) or gonorrhea (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.003); HIV-negative status (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.002); fewer total (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.002), low-risk (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.005), and high-risk (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.015) HPV types detected; lack of anal HPV18 detection (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.001); never having anally douched (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001); and douching with soapy water (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.009) among those who douched. Unsats were less common among those with histologic HSIL (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.008) and nonsignificantly less common among those with fewer anal canal octants affected by HSIL (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.080), but were more common among those who felt more nervous (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.020) during the examination. Our findings suggest that unsats are more common among GBM with less receptive anal sexual experience. Avoiding douching with soapy water and strategies to aid patient relaxation during sampling may reduce the unsat rate.<\/jats:p>","DOI":"10.1097\/cej.0000000000000321","type":"journal-article","created":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T17:10:11Z","timestamp":1490721011000},"page":"212-216","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence and predictors of unsatisfactory anal cytology tests in a cohort of gay and bisexual men in Sydney, Australia: baseline findings from the Study of the Prevention of Anal Cancer (SPANC)"],"prefix":"10.1097","volume":"26","author":[{"given":"David J.","family":"Templeton","sequence":"first","affiliation":[{"name":"The Kirby Institute, UNSW Australia"},{"name":"Central Clinical School, The University of Sydney, Sydney"},{"name":"RPA Sexual Health, Sydney Local Health District, Camperdown"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Douglass Hanly Moir Pathology, Macquarie Park"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. Mary","family":"Poynten","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmella","family":"Law","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Centre for Applied Medical Research, St Vincent\u2019s Hospital, Darlinghurst"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Hillman","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Australia"},{"name":"Western Sydney Sexual Health Centre, University of Sydney, Parramatta, New South Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle","family":"Farnsworth","sequence":"additional","affiliation":[{"name":"Douglass Hanly Moir Pathology, Macquarie Park"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Fairley","sequence":"additional","affiliation":[{"name":"Melbourne Sexual Health Centre, Alfred Health"},{"name":"Central Clinical School, Monash University, Carlton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepehr N.","family":"Tabrizi","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Infectious Diseases, Royal Women\u2019s Hospital"},{"name":"Department of Microbiology, Royal Children\u2019s Hospital"},{"name":"Department of Obstetrics and Gynaecology, University of Melbourne"},{"name":"Department of Infectious Diseases and Microbiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne M.","family":"Garland","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Infectious Diseases, Royal Women\u2019s Hospital"},{"name":"Department of Microbiology, Royal Children\u2019s Hospital"},{"name":"Department of Obstetrics and Gynaecology, University of Melbourne"},{"name":"Department of Infectious Diseases and Microbiology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew E.","family":"Grulich","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengyi","family":"Jin","sequence":"additional","affiliation":[{"name":"The Kirby Institute, UNSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20231002","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1097\/QAI.0000000000000910","article-title":"Anal cancer screening in men who have sex with men in the multicenter AIDS cohort study","volume":"71","author":"D\u2019Souza","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"R3-20231002","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/1471-2407-12-476","article-title":"Anal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infection","volume":"12","author":"Dona","year":"2012","journal-title":"BMC Cancer"},{"key":"R4-20231002","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1186\/1471-2458-13-946","article-title":"The Study of the Prevention of Anal Cancer (SPANC): design and methods of a three-year prospective cohort study","volume":"13","author":"Machalek","year":"2013","journal-title":"BMC Public Health"},{"key":"R5-20231002","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/QAD.0b013e328333ab8e","article-title":"Performance of anal cytology in a clinical setting when measured against histology and high-resolution anoscopy findings","volume":"24","author":"Nathan","year":"2010","journal-title":"AIDS"},{"key":"R6-20231002","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1071\/SH12045","article-title":"Practising high-resolution anoscopy","volume":"9","author":"Palefsky","year":"2012","journal-title":"Sex Health"},{"key":"R7-20231002","doi-asserted-by":"crossref","first-page":"e78291","DOI":"10.1371\/journal.pone.0078291","article-title":"Use of human papillomavirus DNA, E6\/E7 mRNA, and p16 immunocytochemistry to detect and predict anal high-grade squamous intraepithelial lesions in HIV-positive and HIV-negative men who have sex with men","volume":"8","author":"Phanuphak","year":"2013","journal-title":"PLoS One"},{"key":"R8-20231002","article-title":"Pap smear in the prevention of HPV-related anal cancer: preliminary results of the study in a male population at risk","author":"Pisano","year":"2015","journal-title":"G Ital Dermatol Venereol"},{"key":"R9-20231002","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1097\/QAD.0000000000001045","article-title":"A prospective study of anal cancer screening in HIV positive and negative men who have sex with men; 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