Background There is a paucity of evidence and guidance for genitourinary medicine (GUM) clinicians on the management of cervical warts (CW). These patients are either treated in a routine clinic without colposcopy examination (CE) or referred to gynaecology.
Aim To describe the management of patients in a GUM diagnostic colposcopy service where a CE (×7 magnification) performed before and after application of 5% acetic acid to the cervix to identify flat acetowhite epithelium (AWE) in addition to the CW.
Methods Notes of patients who attended the service with a diagnosis code of C11 between June 2006 and December 2011 were reviewed and 48 patients with CW were identified. Details of demographics, presenting features, associated STI, cervical cytology, biopsy results, treatment and follow-up were analysed.
Results Median age of 48 patients was 24 years (range 16–63); 23 (47.9%) were Caucasians, 16 (33.3%) Afro-Caribbeans. 25 patients had no prior cervical cytology as they were under 25 years of age. Of the 23 patients who had a previous cervical cytology, six had a history of abnormal smears. 17 (35.4%) had CW alone, 31 (64.6%) also had vulvo-vaginal/perianal warts. Seven (14.3%) had other concomitant STIs.15 (30.6%) had AWE that on biopsy showed histopathological evidence of HPV and, 10/15 (66.7%) also had evidence of CIN1/2. Of the 33 patients with no AWE, histopathology was available on 23 CW which showed CIN1/2 in 16/23 (69.5%). 10/48 (20.8%) patients were treated with electrocautery, 11 (22.9%) with excision biopsy and 26 (54.2%), with both. 31 patients responded after the first treatment; nine had a further 1–3 treatments. One recurred after 6 months. 26 patients with associated CIN were referred to gynaecology.
Discussion We report a high prevalence of CIN in CW and in associated subclinical lesions in this predominantly young cohort of women, suggesting the need for colposcopy to assess cervical warts or more careful follow-up with cervical cytology.