A 26-year-old woman tested positive for high-risk HPV type 16 on routine cervical screening. Colposcopy reveals a dense acetowhite lesion at the TZ with coarse punctation. Biopsy confirms CIN2. She is nulliparous. What is the CURRENT guideline-recommended management?

• A Immediate LLETZ to prevent progression to invasive carcinoma
• B Hysterectomy due to high-risk HPV 16 persistence
• C Colposcopy and cytology at 6 months with LLETZ only if persistent or progressive ✓
• D Cryotherapy followed by repeat HPV testing at 12 months

Explanation

Current guidelines (ASCCP 2019, endorsed by FIGO) for CIN2 in women under 25–30 years who wish to preserve fertility recommend an observational approach with colposcopy and cytology every 6 months for up to 24 months, as CIN2 has a high spontaneous regression rate (~50% in 2 years). Treatment (LLETZ) is performed if lesions persist or progress. Immediate treatment is acceptable for women who do not desire fertility preservation. Cryotherapy is not preferred for large or endocervical TZ lesions.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.