Copyright @ 2007 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited. Effect of Cervicitis on Visual Inspection With Acetic Acid Carol A. Davis-Dao, MS, 1 Miriam Cremer, MD, MPH, 2 Juan Felix, MD, 3 and Victoria K. Cortessis, PhD 1 1 Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, 2 Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, and 3 Department of Pathology, Women_s and Children_s Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA h ABSTRACT Objective. The objective of this study was to determine whether the presence of cervicitis influenced the accuracy of visual inspection with acetic acid (VIA). Materials and Methods. In a pilot study, 502 women from rural El Salvador were screened for cervical cancer using methods including colposcopy and VIA. The pre- sence of cervicitis was assessed by grading the amount of inflammation on each woman_s cervical biopsy. Data from 495 women found to be free of cervical neoplasia were analyzed for the present study. Results. In this study population, 74% of women were classified as having cervicitis. Both the result of visual inspection and the result of colposcopy were highly associated with the presence of cervicitis ( p = .007 and p = .006, respectively). Women with cervicitis were twice as likely to have a positive VIA result as women without cervicitis (odds ratio = 2.0, 95% CI: 1.0Y3.7). Conclusions. The presence of cervicitis may influence the accuracy of results obtained from colposcopy and VIA. This observation may be of particular importance in low- resource settings such as El Salvador where visual inspec- tion methods are more commonly used in screening for cervical cancer. h Key Words: cervical cancer screening, cervicitis, colposcopy, visual inspection with acetic acid C ervical cancer is the leading cause of cancer death in Latin American women [1]. In El Salvador, mortality is particularly high, 18.4/100,000. In developed countries, cytology-based screening programs have reversed trends of increasing rates [2, 3], significantly decreasing both incidence and mortality. In low-resource settings, cytology programs are limited by lack of infrastructure. Many developing countries are therefore seeking alternative screening methods. Visual inspection with acetic acid (VIA) is gaining popularity for cervical cancer screening in developing countries. It involves application of 3% to 5% acetic acid to the cervix and examination with the naked eye. If acetowhite lesions are observed, the result of the examination is positive. Positive lesions are often treated immediately with cryotherapy. The decision to provide immediate treatment depends on the lesion size, suspicion of invasion, and the examiner_s expertise [4Y7]. Sensitivity of VIA is 66% to 96%, and specificity is 64% to 98% [4]. Advantages of VIA are as follows: low cost, use of readily available materials, and imme- diate results. A disadvantage is potential overtreat- ment because the positive predictive value of VIA is 18.6% [4]. Cervicitis complicates VIA because redness and inflammation may increase false-positive results. Some experts consider clinically apparent cervicitis a contraindication to cryotherapy. Others recommend initial antibiotic treatment of cervicitis and cryother- apy 2 weeks later [7]. Cervicitis is relatively common, with prevalence in high-risk populations reported as 33% [8, 9]. Reprint requests to: Miriam Cremer, MD, MPH, Department of Obstetrics and Gynecology, New York University School of Medicine, 550 1st Avenue, NBV 9E2, New York, NY 10016. E-mail: mlcremer@hotmail.com This study was conducted in El Salvador. Ó 2008, American Society for Colposcopy and Cervical Pathology Journal of Lower Genital Tract Disease, Volume 12, Number 4, 2008, 282Y286