A4. Preinvasive lesions of the cervix

Low-risk human papillomaviruses (HPVs) can cause genital warts which, although benign, may provoke psychological distress because they are sexually transmitted. High-risk HPVs can cause cervical intraepithelial neoplasia and cancer. Cytology-based screening programs have significantly reduced cervical cancer morbidity and mortality where the programs have been successfully implemented. Womenwithabnormalcervicalsmearsare referred for colposcopic assessment, which may confirm the presence of a preinvasive lesion;allows the grade and extent of the lesion to be defined;and guides the colposcopist as to the most appropriate site for biopsy and histologic confirmation of the lesion. Excision of the transformation zone of the cervix in an outpatient setting using local anesthetic has greatly simplified the treatment of premalignant lesions, but long-term follow-up is essential to ensure that the lesions neither persist nor recur. Abnormal cytologic findings during adolescence and pregnancy need special management.