Relation between falciparum malaria and HIV seropositivity in Ndola, Zambia.

Women under the age of 20 years constituted a small minority of those attending the colposcopy clinic.This mainly reflects the small number of women of this age group who were screened.During the period of the study 46/1000 smears in girls under the age of 20 years were abnormal (range 41/1000 in 1982 to 69/1000 in 1985), the pick up rate for all ages being 65/1000 during that period (personal communication M Colquhoun, department of cytopathology, University of Edinburgh).This is two to three times the pick up rate reported by Sadeghi.5It is also of interest that in our study over half the patients had evidence of cervical human papillomavirus infection and that 68% of patients with external genital warts also showed cervical intraepithelial neoplasia.Significantly, two thirds of patients with vulval warts and normal findings on cervical cytology had cervical intraepithelial neoplasia, koilocytosis, or both.It is difficult to escape the conclusion that cervical screening may not be detecting all precancerous lesions and that patients with external genital warts should have colposcopic assessment even if their cervical cytology is reported as normal.The discovery of premalignant lesions of the cervix in increasing numbers of teenagers is worrying.While none of our teenagers had invasive disease, 25% of the whole group (31% of those with abnormal cervical cytology) had cervical intraepithelial neoplasia grade III, which supports a policy of especial vigilance in this group and suggests that the onset of cervical screening should start from an earlier age than currently recom- mended.