Anal Intraepithelial Neoplasia, Anal Warts & Cancer

AIN.  HPV. What Do These Initials Mean?

In these times of abbreviations and limiting complex issues to under 140 words, important items seem to get lost in the abbreviations (OMG!).  However, anal infectious diseases pose threats to all of us. This is especially true for the Human Papilloma Virus, or HPV.  The virus is the cause of anal warts as well as anal (and cervical) cancer.  Anal cancer is thought to begin as an infection which evolves through stages.  This infection causes cellular changes known as anal intraepithelial neoplasia, or AIN.  Therefore, regular exams and screenings by a proctologist, also known as a colon and rectal surgeon, are important.  Why?

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Why?  AIN.

If an HPV infection is detected early enough and the infection eradicated, the progression to cancer can hopefully be stopped. When the anal area is infected with HPV, the virus enters the cells, setting up an inflammation which may ultimately result in the transformation to anal cancer.  The infection can be seen microscopically and is termed anal intraepithelial neoplasia, or AIN.  It is graded as AIN I, AIN II and AIN III, with each stage being more advanced.  The anal cells become disorganized, resulting in dysplasia, which is a step along the path to anal cancer.

HPV has many subtypes, each relating to a different form of disease.  And, here is the key point:  Most people, when infected, are infected by more than one subtype and are therefore subject to developing a number of different diseases.  In this case, we worry specifically about anal cancer and anal warts, also known as condyloma acuminata.  And that is how all of this ties together.  With visible disease, such as anal warts, your surgeon worries about co-existing anal cancer or pre-cancer.  HPV has many faces.

Who Is At Risk?

Technically, all sexually active people are at risk.  Higher risk groups include HIV negative gay males, HIV positive gay males, a small number of women, gay and straight, who are thought to have cervical abnormalities and others in the population with as of yet unknown risk factors.


In at risk groups, or for simple peace of mind, screening is available.  The first step in screening is to speak confidentially and openly with your proctologist.  Following this, an anal exam will be performed and a Pap smear may be performed.  A Pap smear is done by your physician who will place a soft brush into your anal opening in order to obtain cells for examination.  A pathologist will examine the Pap smear cells under a microscope and will look for, and grade AIN.  If AIN is present, diagnostic steps will be taken and treatment may be initiated (not all levels of AIN are treated.)  Importantly,  if, during your visual exam, your doctor sees anal warts, this will serve as an indication that other subtypes of HPV may be present, heightening the suspicion and surveillance.


Anal warts can be eradicated.  HPV can be cured.  AIN can be stopped in its tracks.  While eradication can be accomplished, it may be more difficult in HIV positive individuals.  But, it can be done.  The strategies to do so are complicated and involve several different modalities, or techniques.  The treatments are divided into medical, topical therapies, and surgical therapies.  The key point is that you obtain care from a knowledgeable and experienced physician.

Los Angeles Colon and Rectal Surgical Associates

Skilled, experienced and knowledgeable surgeons are available at Los Angeles Colon and Rectal Surgical Associates.  The surgeons are board certified and schooled in all techniques of treatment.

By calling (310)273-2310, you can schedule your first confidential consultation.  Education and attentiveness to your body are important, and the staff of Los Angeles Colon and Rectal Surgical Associates will help you through all issues related to diseases of the colon, rectum and anus.

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