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On the other hand, severe dyskaryosis (as in Case History 2) warrants an urgent referral to colposcopy. This patient should be seen within 2 weeks. A colposcopic examination should be performed with the aim of establishing a diagnosis. Careful counseling should be offered to the patient with a discussion around the option of see and treat (excisional LLETZ) versus punch biopsy with the options of observation alone, or treatment once the diagnosis has been established. Treatment options include excisional LLETZ or ablative treatments such as cold coagulation, acknowledging the increasing preterm birth rates associated with deeper excisions. If CIN 1–2 is diagnosed it is reasonable to have these cases reviewed, both histology and cytology at the local colposcopy multidisciplinary team (MDT) meeting with the option of conservative management in the form of 6 monthly colposcopy attendance and cervical screening, progressing to treatment should the patient develop symptoms suspicious of cancer or the CIN rises to CIN 3 or 2 years have elapsed with no cytological resolution.

If CIN 3 is detected along with any suggestion of a glandular abnormality or cancer, then excisional rather than ablative treatment should be offered promptly.

In those with CIN, the aim is to keep the depth of excision to >7 mm but <10 mm where possible. All patients with CIN should be offered HPV test of cure testing with their general practitioner 6 months following treatment, and ideally fertility treatment should be deferred until this result is known.