Recallab › Question bank › Gynaecology › #50089
Cervical screening: VIA positive
A 36-year-old woman attends a screening camp under the national programme. Visual inspection with acetic acid shows a dense, well-defined acetowhite area abutting the squamocolumnar junction. She has no symptoms and the cervix looks otherwise healthy. What is the next appropriate step?
- correctA. Colposcopy with directed biopsy
- B. Repeat visual inspection with acetic acid after one year
- C. Immediate total hysterectomy
- D. Reassure her, as the test is not diagnostic
Explanation
Key fact
A screening test that is positive leads to a diagnostic test, never to treatment. Visual inspection screens; colposcopy and biopsy diagnose.
Colposcopy with directed biopsy. She has screened positive, and histology is what establishes whether anything is actually there.
Why
A dense acetowhite lesion touching the squamocolumnar junction is a positive screen.
Visual inspection is cheap and effective but has limited specificity.
Many positives are metaplasia or inflammation, not neoplasia.
Colposcopy identifies the most abnormal area to biopsy.
Only histology can grade cervical intraepithelial neoplasia or exclude invasion.
A positive screen leads to a diagnosis, never to treatment
Why not the others
- B. Repeat visual inspection with acetic acid after one year — abandons a positive screen for a year and risks progression.
- C. Immediate total hysterectomy — treats a disease that has not been diagnosed. Most screen-positive women have no cancer, and precancer is treated by ablation or excision, not hysterectomy.
- D. Reassure her, as the test is not diagnostic — is half right and wholly wrong. It is not diagnostic, which is exactly why the next test is needed.
Remember
Screen positive means test further, not treat. The two are different jobs and different tests.
Go deeper
The national programme screens women aged 30 to 65 every five years with visual inspection; HPV DNA testing is the more sensitive alternative and is being adopted.
In a see-and-treat protocol, cryotherapy may be given at the same visit where colposcopy is unavailable and the lesion meets strict criteria.
HPV vaccination at 9 to 14 years is the primary preventive measure and does not replace screening.
Park K. Park's Textbook of Preventive and Social Medicine, 28th ed. (Bhanot, 2025); DC Dutta's Textbook of Gynecology, 9th ed. (Jaypee, 2023).