Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

Although a concentration between 3% and 5% is recommended for the acetic acid to be used, we recommend using 5% acetic acid. This ensures that the lesions are visualized distinctly and does not cause any vaginal irritation.

Ingredients required for preparation of 100 mL of 5% acetic acid:

• Glacial acetic acid: 5 mL
• Distilled water or boiled water at room temperature (after boiling for 20 minutes): 95 mL

Apparatus and consumables required:

• Graduated measuring cylinder (capacity, 100 mL)
• 10 mL syringe
• Pair of gloves
• Bottle with stopper for storing 5% acetic acid

Preparation:

• Pour 95 mL of distilled or boiled water at room temperature into the cylinder.
• Carefully measure 5 mL of glacial acetic acid with the syringe, add it to the measuring cylinder, and mix thoroughly.
• Pour the dilute 5% acetic acid into the storage container.
• If the volume of dilute acetic acid to be prepared changes, the volumes of glacial acetic acid and water will change proportionately (e.g. 20 mL of 5% acetic acid = 1 mL of glacial acetic acid + 19 mL of distilled water).

Label: 5% dilute acetic acid prepared on dd/mm/yyyy.

Storage: Store in a tightly capped bottle. Unused acetic acid should be discarded at the end of the day. Acetic acid is hygroscopic and attracts moisture from the atmosphere. This causes the solution to get diluted easily. Therefore, the solution should be freshly prepared daily before the clinic starts.

Caution: It is important to dilute the glacial acetic acid, because undiluted acetic acid causes a severe chemical burn if applied to the epithelium. If a burn occurs, wash immediately with a liberal amount of clean water. It is always a good practice to keep the bottle of glacial acetic acid clearly labelled and keep it away from the room where the examination is performed.