Managing CIN II: Follow-Up Pap Smears and HPV Considerations

Pap smear follow-up

Hello Doctor, I had a Pap smear in November 2019 that showed CIN II.
I underwent a large loop excision of the transformation zone (LEEP) at National Taiwan University Hospital, which also confirmed CIN II.
I have been monitored every six months since then, with varying results.
My last Pap smear was abnormal with a result of 11, and a subsequent biopsy indicated inflammation (the HPV virus has been cleared).
The doctor advised me to follow up in six months.
My next follow-up is scheduled for June, but due to the pandemic and considerations regarding healthcare resources, should I postpone my visit or proceed with the hospital check-up as planned?

Ivy, 40~49 year old female. Ask Date: 2021/05/23

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, delaying a bit until the pandemic subsides will not have an impact.
Wishing you good health.

Reply Date: 2021/05/23

More Info

Managing CIN II, or Cervical Intraepithelial Neoplasia grade 2, requires careful monitoring and follow-up to ensure that any potential progression to cervical cancer is caught early. Given your history of CIN II, the fact that you underwent a LEEP (Loop Electrosurgical Excision Procedure) and have been following up with Pap smears every six months is a standard and recommended approach.
The abnormal Pap smear results you mentioned, particularly the "11" result, indicate that there may be some atypical cells present, which could be a sign of inflammation or other changes. It’s important to understand that even after treatment, there is still a possibility of abnormal results due to residual effects from the previous CIN II or new HPV infections. The fact that your HPV virus has been cleared is a positive sign, as persistent HPV infection is a significant risk factor for the development of cervical cancer.

In terms of follow-up, if your doctor has advised you to continue with the six-month follow-up, it is generally advisable to adhere to this schedule unless there are specific concerns that warrant earlier intervention. The ongoing pandemic has indeed affected many healthcare services, but it is crucial to prioritize your cervical health. If your healthcare provider believes that your situation is stable and manageable, it may be acceptable to continue with the scheduled follow-up. However, if you have any new symptoms or concerns, such as unusual discharge or discomfort, it would be prudent to seek medical attention sooner rather than later.

Regarding the type of Pap smear, both traditional and liquid-based (thin-layer) Pap smears are effective for screening. The choice between the two often depends on the healthcare provider's preference and the resources available. Liquid-based Pap smears may offer some advantages in terms of sample collection and the ability to test for HPV simultaneously, but traditional Pap smears are still widely used and can be effective.

As for the water-like discharge you mentioned, while it may not be directly related to your CIN II history, any new or unusual discharge should be evaluated by a healthcare professional. It could be a sign of an infection or other gynecological issue that may require attention.

In summary, continue to follow your doctor's recommendations for regular Pap smears and HPV testing. If you have any concerns about your symptoms or the timing of your follow-up, do not hesitate to reach out to your healthcare provider for guidance. Regular monitoring is key to managing CIN II effectively and ensuring that any potential issues are addressed promptly.

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