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Author20 Posts
  #1

A 22-year-old sexually active white female comes to your office for a pelvic examination. She has no complaints, but you find a flat wart on her cervix.

The most appropriate management is



a. explaining to her that warts are harmless, although contagious, and giving her the option of having it treated or left alone
b. reassuring her of the benign nature of these lesions and offering her treatment with either podophyllin or liquid nitrogen
c.reassuring her if her Papanicolaou test is negative, and scheduling a return visit in 3 months
d. performing a colposcopically directed biopsy of the lesion to rule out cervical neoplasia




  #2

answer c


  #3

one has to perform a biopsy to rule out cervical neoplasia even though its a flat wart


  #4

I think if the pap smear is negative the best choice would be to repeat the pap smear in 3 months rathe than to go for colpscopy and biopsy directly.


  #5

I think d is right.


  #6

I agree. colposcopy is not a big deal in clinical practice and it is the answer. :lol:


  #7

I think c is the best option for her.


  #8

Hi, isn't it true that Subtypes of HPV that cause warts are different than the ones that Cancer. If this woman has a normal Pap, then repeat exam is all that is necessary.


  #9

conservative is good :wink: wait 3 months is the pap changes then proceed with biopsy.


  #10

Why not option B Rx with liquod Nitrogen or Podophylin May be better. We are not told that she is a candidate for Ca CX because of multiple partners and so on.Potion C Pap smear is Negative. Then what about Rx of Warts?
Please answer.


  #11

(1) do a pap smear to r/o Ca Cx AND do DNA testing to check if it could
be premal aka HPV 16 or 18, 31, 35.

(if it is 6 & 11 then do pap once a year)

(2) if pap smear abnormal then do colposcopy and ECC

(3) if histology worse than pap then do cone biopsy

hope that helps


  #12

Thanks for the explonation.
So coming back to the q above do u agree with me in choosing the ans of Rx with Podophyllin Or liquod Nitrogen . I checked in Kaplan OB GYN Page 131. Please reply.


  #13

i would personally go with option c

get a pap smear and if neg then reschedule in 3 months

condyloma accuminatum aka 6 & 11 are cauliflower type warts....so if u saw those...yeah sure go with the topical podophyllin or nitro


  #14

Yes. It is said in the question that there is a wart. So it has to be treated. Right.And by the way why do we check Pap smear in 3 months. Does it put her under risk of develpoing Ca Cervix. I do not think so. So where is the need to do pap after 3months.Please explain.


  #15

it is a flat wart that is described in the question stem not a cauliflower wart.

also u need to do a pap smear in 3 months time to r/o malignancy....this is because a pap smear is only of a certain region (t zone) and may sometimes miss a premal lesion.


  #16

Yes. Now I got it . I agree with u. I thought Flat wart is the same HPV type6and 11. But now it is clear.
Thanks.


  #17

why not colposcopy?
It is clinically avalaible and we have less false negative result as with pap alone.... not have to wait for a three more months for the surprise of a positive result ( and even a one more fallse negative )....
:wink:


  #18

the first thing u would do always is to have a pap smear done first......if that coms back abnormal then a coloposcopy and ECC are done

ALWAYS the screening test b4 anything else


  #19

:o isnt a flat wart consistant with accumulata lata---


  #20

i'd go for pap smear. pap has to be done annually if sexually active until negative for 3 yrs.





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