Treatment by cryotherapy – Post-treatment advice and follow-up
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- Explain to the woman that she will have a clear or slightly bloodstained watery vaginal discharge that may persist for up to 4 weeks, and she may have to use sanitary towels.
- She should avoid tampons.
- Inform her of the following warning signs that may occur within 4 weeks:
- Foul-smelling, purulent vaginal discharge
- Fever for more than 2 days
- Moderate to severe lower abdominal pain
- Excessive vaginal bleeding (other than the blood loss during normal menstruation)
- Bleeding with clots
- If the woman develops any of the above-mentioned symptoms, she should return to the clinic without delay or seek medical attention elsewhere.
- Counsel the woman not to have sexual intercourse for 4–6 weeks because this may cause bleeding from the raw wound and/or infection. (Note: If the couple is unable to abstain from sexual intercourse, the man should use a condom.)
- Advise her to return for follow-up as described later.
Antibiotics are not routinely prescribed after cryotherapy. Paracetamol tablets may be given for 1 or 2 days for pain.
Follow-up after cryotherapy:
- Advise the woman to return to the clinic for a check-up after 1 month to ensure that she does not have any complaints. Review the histopathology report if a biopsy was obtained just before cryotherapy. In a screen-and-treat programme, the 1-month follow-up visit is often omitted.
- Recall the woman for the next check-up after 12 months.
- The HPV test is the preferred test to be done at the 12-month follow-up visit. If the HPV test is not available, cytology or VIA should be performed. The cervix can be evaluated with colposcopy.
- If there is a persistent lesion at follow-up and/or the HPV test result is positive, it is preferable to excise the transformation zone, although cryotherapy may be repeated if the usual criteria for ablation are fulfilled.
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