University Of Tasmania

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Front-to-back and dabbing wiping behaviour post-toilet associated with anal neoplasia and HR-HPV carriage in women with previous HPV-mediated gynaecological neoplasia

journal contribution
posted on 2023-05-18, 20:15 authored by Steve Simpson JRSteve Simpson JR, Penelope BlomfieldPenelope Blomfield, Cornall, A, Tabrizi, SN, Christopher BlizzardChristopher Blizzard, Richard TurnerRichard Turner
BACKGROUND: Anal cancer is a human papillomavirus (HPV)-mediated neoplasia of the anal squamous epithelium. Anal cancer is much more common among women, particularly those with a previous high-grade gynaecological neoplasia.

METHODS: Cross-sectional study of women with a previous HPV-mediated gynaecological neoplasia in Tasmania, Australia. Women presenting for follow-up gynaecological care had anal swab samples taken for anal cytology by Hologic Liquid ThinPrep, followed by HPV genotyping. Women with abnormal anal cytology were invited for high-resolution anoscopy. Potential risk factors, including post-toilet wiping behaviours, were queried by questionnaire while clinical covariates were extracted from medical records. Covariates of anal outcomes evaluated by log-binomial and log-multinomial regression.

RESULTS: From 163 women enrolled in the study, 65 (39.9%) had abnormal cytology, with 46 (28.2%) being high-grade. Of the 50 women with abnormal anal cytology having high-resolution anoscopy, 32 (64.0%) had abnormal histology with 13 (26.0%) being high-grade. Of the 123 women tested for HR-HPV DNA, 48 (39.0%) had HR-HPV detected, the most common genotypes being 16 and 51 (14/123, 11.4% for both). In addition to some known anal cancer risk factors, we found front-to-back wiping was associated with significantly increased (Prevalence ratio (PR) range: 1.99-3.60) prevalence of cytological and histological abnormality and HR-HPV carriage/co-carriage, while dabbing post-toilet was significantly associated with decreased prevalences (PR range: 0.50-0.62).

CONCLUSIONS: Post-toilet wiping behaviours were significantly associated with the prevalence of anal cytological, histological and HR-HPV carriage outcomes. This suggests a biologically plausible mechanism for HR-HPV introduction and the higher frequencies of anal neoplasia in women.


Publication title

Cancer Epidemiology








Menzies Institute for Medical Research


Elsevier Inc.

Place of publication

United States

Rights statement

Copyright 2016 Published by Elsevier Ltd.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified