Cervical dysplasia

Invasive cervical carcinoma is a human papillomavirus-driven squamous or glandular cancer staged by FIGO criteria, treated with fertility-sparing or radical surgery for early disease and cisplatin-based chemoradiation for locally advanced disease.

Human papillomavirus is a nonenveloped DNA virus with low-risk types (6, 11) that cause warts and high-risk types (16, 18, and others) that drive cervical, anal, vulvar, penile, and oropharyngeal cancer, prevented by 9-valent vaccination and managed by type-specific screening rather than treatment of the virus itself.

Condyloma acuminata are soft, verrucous anogenital warts caused chiefly by human papillomavirus types 6 and 11, diagnosed clinically on inspection, and treated with patient-applied imiquimod or podofilox or provider-administered trichloroacetic acid or cryotherapy, with 9-valent HPV vaccination as the primary prevention.

Acute cervicitis is inflammation of the uterine cervix diagnosed by visualized mucopurulent endocervical discharge or a friable os that bleeds with a swab, most often caused by Neisseria gonorrhoeae or Chlamydia trachomatis, treated empirically at the same visit while nucleic acid amplification testing is pending.

Primary vaginal cancer is a rare gynecologic malignancy, usually squamous cell carcinoma linked to HPV, that must be distinguished from the far more common metastatic or direct extension of cervical, endometrial, or vulvar cancer into the vagina. Diagnosis rests on biopsy of a visualized lesion with clinical FIGO staging, and treatment is predominantly radiation with concurrent platinum-based chemosensitization.

Vulvar cancer is usually squamous cell carcinoma of the vulvar skin, arising either from high-risk HPV infection (younger, premenopausal patients) or from long-standing lichen sclerosus (older, postmenopausal patients), and is confirmed by punch biopsy of any persistent vulvar lesion or unexplained pruritus; treatment is surgical, with radical vulvectomy and inguinal lymphadenectomy for invasive disease.

Acute HIV infection, also called the acute retroviral syndrome, is the symptomatic viremic phase in the days to weeks after HIV acquisition, presenting with fever, fatigue, myalgia, rash, and pharyngitis at a time when antibody testing may still be negative. Diagnosis requires an HIV RNA viral load, and antiretroviral therapy should begin as soon as the patient is ready, regardless of CD4 count.

HIV in pregnancy is managed by starting or continuing combination antiretroviral therapy in every HIV-positive pregnant patient regardless of CD4 count or gestational age, because fully suppressive ART drives perinatal transmission below 1%, versus 25 to 30% with no intervention at all.

Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection in the United States, frequently asymptomatic, and diagnosed by nucleic acid amplification testing of urine or genital/rectal/oropharyngeal swabs. Uncomplicated genital infection is treated with a single dose of azithromycin or a course of doxycycline, complications include pelvic inflammatory disease and epididymitis, and LGV serovars require a 21-day course and are an increasing cause of proctitis.

Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.