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High prevalence of anal papillomavirus infection in men who have sex with men PrEP users
  1. Roberto Rossotti1,
  2. Alice Nava2,
  3. Chiara Baiguera1,
  4. Daniele Calzavara3,
  5. Federico D’Amico1,
  6. Diana Fanti2,
  7. Nicholas Brian Bana1,
  8. Chiara Vismara2,
  9. Massimo Cernuschi3,4,
  10. Francesco Scaglione2,5,
  11. Massimo Puoti1,6
  1. 1 Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  2. 2 Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  3. 3 Milano Checkpoint, Milan, Italy
  4. 4 Department of Infectious Diseases, Istituto Scientifico Universitario San Raffaele, Milan, Italy
  5. 5 Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
  6. 6 School of Medicine, Università degli Studi di Milano-Bicocca, Milan, Italy
  1. Correspondence to Roberto Rossotti, Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy; roberto.rossotti{at}


Objectives Human papillomavirus (HPV) is the most common STI and is associated with a wide range of diseases from anogenital warts to malignancies. Anal HPV infection is considerably more common in men who have sex with men (MSM) living with HIV. Aims of the present study are to (i) describe the prevalence of anal HPV infection in MSM who started pre-exposure prophylaxis (PrEP) and (ii) analyse factors associated with anal infection from genotypes that would be covered by nonavalent vaccination.

Methods This monocentric, cross-sectional study included all subjects who started PrEP from May 2018 to November 2021. PrEP candidates underwent full behavioural and clinical evaluation, including digital anal rectal examination and swabbing for HPV determination. Descriptive statistics, Mann-Whitney U test for continuous and χ2 tests for categorical variables were adopted. Unadjusted and adjusted regression analyses were performed to assess factors associated with positive anal swabs and to the presence of genotypes covered by the nonavalent vaccination.

Results The analysis included 288 subjects: anal swabs tested positive in 87.2% of cases, 79.2% of the subjects had a high-risk genotype (mainly 16), whereas 67.4% had a genotype covered by nonavalent vaccine. Sexual role was the only factor associated with anal HPV infection. Use of recreational drugs and a diagnosis of ≥2 STIs correlated with the presence of genotypes that would have been covered by vaccine, while previous vaccination had a protective role.

Conclusions PrEP candidates showed a high prevalence of anal HPV infection, especially due to high-risk genotypes, comparable to what has been reported in MSM living with HIV.

  • PREP
  • papillomaviridae
  • vaccination
  • men

Data availability statement

All the anonymised data used to perform this analysis will be available for any further revision. Not Applicable.

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Data availability statement

All the anonymised data used to perform this analysis will be available for any further revision. Not Applicable.

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  • Handling editor Apostolos Beloukas

  • Contributors RR ideated the study, collected the data, performed the statistical analyses and wrote the paper; CB and NBB collected the biological samples; AN, DF and CV performed the lab analyses for HPV genotyping; DC and MC are physician and peer counsellor working in the PrEP clinic; FD’A helped in data collection and dataset cleaning; FS and MP revised and edited the manuscript. MP is the author responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.