Complications of cervical cryotherapy in adolescents

Cervical dysplasia and human papillomavirus (HPV) infections in sexually active adolescents appear to be increasing. Cervical cryotherapy offers the advantages of inexpensive outpatient therapy that is well tolerated without anesthesia. Previous series have focused on women beyond adolescence and have concluded that the risks and complications are rare. Sixty-seven adolescents underwent cervical cryotherapy for cervical intraepithelial neoplasia (CIN) or HPV infection. Pelvic inflammatory disease developed in 9% within one month of treatment. Two patients developed cervical stenosis and hematometra. Cervical cultures performed prior to cryotherapy were documented to be negative, but the interval from negative cultures to treatment exceeded four weeks in 54% of the patients because of problems with patient compliance with appointments. The risk of infectious complication in our adolescent population prompted a recommendation for aggressive preventive measures, including documentation of recent negative cultures for Neisseria gonorrhoeae and Chlamydia. The use of prophylactic antibiotics should be investigated for adolescents undergoing cervical cryotherapy.