To assess the impact of a diagnosis of anal HSIL on subsequent sexual activity in GBM.
The Study of the Prevention of Anal Cancer(SPANC) enrolled GBM in Sydney who had never previously undergone high-resolution anoscopy(HRA). At baseline and 6-month visits, a behavioural interview, cytological ± histological assessments were performed. We examined the association between a baseline HSIL diagnosis and subsequent changes in sexual behaviour.
Among 617 GBM enrolled (median age 49 years; 35.7% HIV-positive), 518(84%) attended 6-month follow-up. The number of participants reporting any recent casual sex declined among 232(37.6%) men diagnosed with HSIL (76.8% to 67.7%, p=0.050) but not in those negative for any squamous intraepithelial lesion(SIL) at baseline (76.0% to 70.1%, p=0.239). There was also a reduction in median partner numbers in the previous 6-months among men with HSIL (9 vs 5, p=0.048) but not among SIL-negative men (7 vs 5.5, p=0.128). Among both men with HSIL and men without SIL at baseline, the number of episodes of receptive penile-anal sex, rimming, fingering, fisting and toys remained unchanged. Neither presence nor duration of pain or bleeding following baseline HRA were associated with subsequent reduction in partner numbers.
GBM in SPANC reduced casual sexual contact and partner numbers following a diagnosis of HSIL. This could be a conscious decision based on a perception of reducing future risk of anal cancer or a fear of transmitting the causative high-risk HPV infection to partners. Further investigation of the reasons behind this change in sexual activity is warranted.