A 43-year-old woman referred to the Hospital's Lower Genital Tract Pathology Clinic for presenting with a cervico-vaginal cytology reported as "L-SIL" (Low Grade Intraepithelial Lesion). She refers repeated vaginal infections (Trichomoniasis,...) and having had more than 5 sexual partners in her life. The best care strategy for this woman is:
The best answer to this question is number 5. Most of the lesions identified as L-SIL are associated with HPV infection: for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection. On the other hand, according to the latest studies, 70% of the cytologies reported as LSIL will remit, 15% will persist and another 15% will show a more severe cytology, without being able to differentiate whether it is a biological progression or a lesion hidden in the initial cytology. Because of this, it is best to return for a follow-up at 6 months. Given the woman's personal history (more than 5 sexual partners and repeat infections) and her age, a referral for colposcopy would be ideal. However, answer 5 says control in 6 months, but does not specify which control (it could be a colposcopy or cytology).
Conization with diathermy loop.
Endocervical curettage with Kevorkian curettage.
Endometrial biopsy with Cornier cannula.
Hysterectomy without adnexectomy.
Advise her to stop smoking and contraceptives and to have a control in 6 months.
Most of the lesions identified as L-SIL are associated with HPV infection: for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection. On the other hand, according to the latest studies, 70% of the cytologies reported as LSIL will remit, 15% will persist and another 15% will show a more severe cytology, without being able to differentiate whether it is a biological progression or a lesion hidden in the initial cytology. Because of this, it is best to return for a follow-up at 6 months.