Using HPV tests for cervical cancer screening and managing HPV-positive women – a practical online guide

The steps to determine eligibility for ablative treatment require addressing the following questions:

1. Is the SCJ fully visible?
2. Is the SCJ located on the ectocervix or at the external os?
3. Is the size of the lesion (when a lesion is present) less than 75% of the ectocervix?
4. Does the lesion (when a lesion is present) extend to the vagina and/or to the endocervix?
5. Is there any suspicion that the lesion could be an invasive cancer?

The examination of the patient should try to address these questions. The setup, consumables and equipment required, patient preparation, and the steps of the examination are exactly the same as those described for VIA.

On the basis of the findings after application of acetic acid, if the answer to questions 1, 2, and 3 above is YES and the answer to questions 4 and 5 is NO, then the patient is eligible for ablative treatment. If cryotherapy is being used, an additional question to be answered is whether the tip of the largest cryotherapy probe adequately covers the entire transformation zone. Usually, a visual assessment can answer this question. When in doubt, apply the probe on the transformation zone and confirm.

Ablative treatment should not be performed in the presence of active acute infection of the cervix. The patient should be prescribed appropriate antibiotics to treat the infection and recalled for treatment after the course of antibiotics is complete.