Ask Kim: What’s a Rectal Pap?

Dear Kim, 

At the Health Collective Clinic, I have been offered testing by rectal swab, which I usually choose to get since I have anal sex. One time when I visited I had some unpleasant anal symptoms and was offered a rectal Pap. Can you tell me what the difference is between that and a rectal swab, and what situations it’s used in? 

Thank you, 

That’s a Lot of Rectal Tests 

Dear That’s a Lot, 

A lot of clinics don’t routinely do rectal swabbing, but we always offer them at our testing appointments! That’s because chlamydia and gonorrhea can be transmitted anally, so it’s important to test all potential infection areas – the throat, urethra (peehole), and anus (butthole). Anyone who has anal sex or oral-anal sex (rimming) should consider having a rectal swab when testing for STI’s. 

Rectal Pap tests serve a different purpose. Most people have probably heard that people with cervixes should get cervical Paps regularly. These test for abnormal cells on the cervix (the entrance to the uterus), which could be cancerous or pre-cancerous and require treatment. Similarly, rectal Paps test for abnormal cells in the rectum that could lead to anal cancer. This way, any danger of cancer can be addressed as soon as possible.  

There are no official recommendations on who should get rectal Pap tests, so different providers may use different guidelines. According to UNC Health, folks at the highest risk for anal cancers are people living with HIV, and so several medical societies recommend yearly screening from ages 25-30 for this group. 

Another indication that a rectal Pap may be recommended is if the individual has had HPV before. HPV is a very common infection that is harmless for most people, but there are a few strains that can lead to cancer, including anal cancer.  

Depending on your provider, there may be other risk factors that lead them to recommending a Pap test. It’s important to be honest with your provider about the kinds of sex you have and any existing or past infections you’re aware of so they can make the best possible recommendations to protect your sexual health. 

Be well, be yourself, 


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