Do we really need guidelines for HRA during COVID-19 pandemic? - Response.

Mistrangelo et al raise a number of issues in connection with the International Anal Neoplasia Society guidelines for the practice of High Resolution Anoscopy (HRA) in the era of COVID-19. The authors suggest that the guidelines advocate \"mandatory\" HRA for \"screening\". On the contrary, the guidelines clearly define risk prioritisation, in terms of both potential COVID-19 exposure and the dangers associated with delayed diagnosis of anal cancers. Centres without access to high quality HRA services may have to rely on digital anal rectal examination to eventually diagnose large anal cancers. HRA has the ability to accurately identify early anal cancers and worrisome pre-cancerous lesions, and thus to facilitate early intervention. It therefore has the capacity to substantially improve survival and quality of life of patients. This remains true in the era of COVID-19, and will be of increasing importance as the epidemic continues and services remain disrupted.