The Role of Early Colposcopy in the Management of Females with First Episode Anogenital Warts

Abstract

212 females attending a genitourinary medicine (GUM) clinic with first episode anogenital warts were screened by cervical cytology and colposcopy/histology for the presence of cervical epithelial abnormalities in keeping with infection by the human papillomavirus (HPV infection) and/or cervical intraepithelial neoplasia (CIN). The prevalence of cervical epithelial abnormalities detected by cervical cytology alone was 32%, rising to 56% after colposcopic examination. However, the majority of cervical lesions detected by colposcopy alone were of low grade (HPV infection and/or CIN I). Histologically-confirmed high grade cervical lesions (CIN II or CIN III) were detected more frequently in those females in whom cervical cytological examination indicated dyskaryosis in keeping with any grade of CIN, compared to females without dyskaryotic changes on cervical smear (P < 0.05, chi-squared test with Yates' correction). Early colposcopy is indicated for females with anogenital warts in the presence of a cervical smear showing dyskaryosis in keeping with any grade of CIN, because of the statistically significant increased risk of detecting a potentially progressive high grade cervical lesion. In females without dyskaryotic changes on cervical smear, the value of early colposcopy is uncertain and warrants larger more long-term trials.

Cervical cytology and colposcopy in clinics for sexually transmitted diseases--when are they appropriate?

“…'3 Colposcopy studies of women with vulval warts, performed before widespread cytology screening began, showed high levels (16-9%) of CIN 2 and 3,14 but more recent studies have shown much lower levels of 0_3.3%. [15][16][17] In the one study with a control group there was no difference in the colposcopy findings of the women with warts and the controls. 15 The NHS Cervical Screening Programme guidelines'8 recommended that women presenting with vulval warts should have a cervical smear taken and the result should determine whether or not colposcopy is needed.…”