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High Resolution Anoscopy (HRA)

Fenway Health is proud to offer Anal Dysplasia screening with our High Resolution Anoscopy (HRA) clinic. Fenway Health has been a leader in anal dysplasia care with the creation of our HRA clinic in 2003, with the intent of serving and supporting the needs of our patients. Our clinic is the largest in New England offering HRA services. Dr. Ami Multani serves as the Medical Director of our HRA clinic which is staffed by Dr. Multani and Julie Thompson PA-C.

  • Human Papilloma Virus (HPV) is the most common sexually transmitted disease, it is transmitted from intimate skin to skin contact. For more information, please see:
  • Anal cancer is highly associated with the human papilloma virus (HPV), which has a tendency to infect certain areas of the body such as the genitals, cervix, rectum and sometimes the throat. Medical providers have long been aware of how HPV affects the cervix but we now know that it can cause similar changes in the rectum as well.
  • HPV tends to affect a specific part of our tissue called a “transformation zone”.  This is where the thick, “outside skin cells” (squamous cells) meet the thinner “inside skin cells” (columnar cells) which line the inside of our bodies. There are transformation zones located in the throat and rectum of all people, as well as the cervix. There are over 100 types of HPV, and some types are more dangerous than others. These types tend to be divided into two groups, “low risk” types and “high risk” types. The low risk types are often benign, although they can sometimes cause genital warts. The “high risk” types can also be benign but they can also sometimes be associated with pre-cancerous lesions (which often can not be seen or felt) and an increased risk of developing cancer. Fortunately, naturally clearing HPV is possible and actually quite common in young, healthy individuals. However, there are risk factors that can make it more difficult
    for our bodies to clear HPV in certain patients and thereby cause dysplasia.
  • Similar to how pap smears are used to screen for HPV changes in the cervix, we can now use pap smears to screen for HPV changes in the rectum as well. Your PCP will help you to decide if getting an anal pap smear is appropriate for you.
  • HRA or High Resolution Anoscopy is the use of a small diameter tube (an anoscope) and a light source with magnification, as well as the use of acetic acid (vinegar) and iodine, to closely examine the internal anus and rectum, usually for signs of HPV (Human Papilloma Virus) disease including genital warts as well as precancerous changes.
  • This is a very different procedure from a colonoscopy or a flexible sigmoidoscopy, neither of which adequately examine the anal canal for HPV changes.
  • The cells collected and examined during your anal pap smear have shown some abnormalities. The HRA procedure will allow for a comprehensive assessment of this finding.
  • For more information you can also check out: This is a great website that provides some more accurate information about anal HPV and screening.
  • This procedure can be performed at our main health care center in the Fenway neighborhood at 1340 Boylston Street. An appointment can be made by calling 617.927.6000 and asking for an “HRA” appointment.
  • A referral may be required by your insurance company. If you receive your primary care at Fenway Health, please contact your nurse and we will work on this for you.
  • If you are NOT a patient who receives their primary care at Fenway Health, please ask your PCP to fax us your medical records to 617-247-3912 prior to your medical appointment or please bring a copy of your medical records with you to your appointment. Also, please plan to arrive to your appointment 30 minutes early to complete any necessary insurance paperwork.
  • We do have a “Late Patient Policy”, unfortunately if you arrive over 10 minutes past your appointment start time, we may need to reschedule your appointment to a later date.
  • No special preparation is needed. Please eat, as you normally would, prior to your visit.
  • Please do not insert anything into your anus for the 24 hours prior to your appointment, including enemas or douches. Routine hygiene is all that is required.
  • It is important to arrive on time for your visit, preferably 10-20 minutes prior to the start time of the visit. Prior to the procedure, the specialist will spend some time talking to you and answering any questions. The procedure itself typically takes less than 30 minutes.
  • Please let your specialist know if you are taking any blood thinners like aspirin, warfarin, clopidogrel, prasugrel, etc.
  • Please let your specialist know if you have allergies to iodine or topical anesthetics including lidocaine.
  • The procedure will be performed in a private room that is equipped for this purpose. Usually, the only people present will be you, the medical assistant and the specialist unless we ask your permission to have another person present.
  • We will help to position you on the exam table. A small tube called an anoscope is inserted into the anus. During the examination, if an abnormal appearing area is visualized, a biopsy may be taken. A biopsy is a small sample of tissue (< 5mm in size) that is sent to the pathology lab for analysis. Taking the sample may be painless or feel like a quick pinch.
  • Please reschedule your appointment if you are experiencing acute diarrhea, abdominal pain or fever and speak with your PCP instead.

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