ks704 Thu Jun 04, 2009 2:40 pm
Hello,
This is a common case and it is a perfectly reasonable question...what do you do next?
The management options here should be agreed between the colposcopist and the patient, after all we have been taught about the importance of individual patient centred-approach. I doubt that there will be definitive guidelines in this case (unless Dr Kamal wishes to comment). For instance, I clerked a 25 yr lady who came in for a follow-up to discuss her cervical smear results. She was found to have mild dyskaryosis with evidence of HPV infection. Her history, otherwise, was unremarkable.
As suggested in Impey, she should come back for repeat smear in 6 mts but the Consultant was adamant to bring her back in 3 mts on top of doing a colposcopy. The guidelines change so often but certainly towards a more aggressive approach to treatment.
Back to your case, depending on the colposcopist and patient, they have the following options:
1. continue monitoring the patient as follow-up since 2/3 of CIN1 regress spontaneously as well as offering advice on the importance of barrier contraception to prevent any further STIs (since HPV is a STI). Smears can be repeated 3-6 mts, HPV testing every 12 mts and colposcopy every 6 mts. It also depends on how motivated the patient is to turn up to appointments.
2. remove the lesion using surgical intervention such as cryo, cone bx, lletz or leep (same thing) which are usually indicated in CIN 2/3. It is also important to warn the patient about risks and both major and minor complications of invasive procedures (i.e. standard vs specific).
Hope this helps at all.
Best wishes,
KS
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