High Resolution Anoscopy (HRA)

What is an HRA? 

HRA stands for high resolution anoscopy. It is a procedure used to visualize the internal anal mucosa under high magnification using special dyes to detect pre-cancerous cells and condyloma (genital warts).

What Causes Genital Warts and Rectal Cancer? 

The most common STI (sexually transmitted infection) in the world: HPV. There are over 120 different strains of HPV, with the majority causing rectal inflammation that the body normally clears in 1-2 years. However, about 16 of the strains can cause precancerous change that can lead to rectal cancer. Four of the strains can cause genital warts.

How can I get tested for HPV? 

Rectal HPV is usually detected with an anal pap smear which is a special q-tip that collects rectal cells that are then examined under a microscope. If you’re not getting a regular anal Pap smear, you’re not getting screened for the most common STI in the world! 

If there are any inflammatory or pre-cancerous changes found on the anal pap smear, the next step is to do an HRA to thoroughly examine the rectum and locate where the abnormal cells are coming from. Under high powered magnification, we can tell if it’s consistent with pre-cancer, inflammation, or genital warts. If needed, a biopsy is taken of any suspicious areas which provides the definitive answer. Numbing medicine is applied and the amount of tissue taken is the size of a pen tip.

How are genital warts treated?

If internal anal genital warts are present or if the biopsy confirms pre-caner, Dr. Elliott can use an IRC laser to remove them in the office after numbing medicine is applied. Dr. Elliott is one of only a handful of physicians in the United States trained to perform HRAs and treat internal anal genital warts using lasers.

Traditionally, patients with internal warts must go to the OR under general anesthesia for surgical removal with downtime and recovery between 2-3 weeks. Using IRC lasers is much less invasive and done in the office. No general anesthesia is necessary, and the recovery is mild with patients back to work in 2-3 days. Dr. Elliott also uses cryotherapy and topical medications for treatment when needed.

How can I prevent HPV?

One of the best ways to protect yourself against cancer-causing and genital wart strains of HPV is with the Gardasil Vaccine. It can provide up to 95% protection against genital wart strands and 92% protection against cancer-causing strands. It is now FDA approved up to age 45 and for good reason! New clinical trials show that not only does it help provide protection against HPV, but it can also help treat current HPV infections. It’s a three part series and one of the most important vaccines to get as gay men.