Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment / Activity 6

Treatment by cryotherapy – Post-treatment advice and follow-up

  

Post-treatment advice:
  • 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 attend the clinic without delay or seek medical attention elsewhere.
  • Counsel the woman not to have sexual intercourse for 4–6 weeks as 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.
Note: 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. No screening test or speculum examination or colposcopy should be done. 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 next check-up after 12 months.
  • HPV test is the preferred test to be done at 12 months follow up visit. Perform cytology or VIA if HPV test is not available. One can evaluate the cervix with colposcopy.
  • If there is a persistent lesion at follow-up and/or HPV test 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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