A 42-year-old G4P4 has had postcoital bleeding for the past four months. She has not had a Pap test since the delivery of her last child 7 years ago. Speculum examination shows a vaginal discharge and a 1 cm exophytic lesion of the posterior cervical lip. The most appropriate next step is:

Question

Quizplus · Accepted Answer

Given the presence of an exophytic lesion on the cervix and the history of postcoital bleeding, a punch biopsy of the lesion is the most appropriate next step to rule out cervical cancer or other pathology. Pap smear is a screening tool, not diagnostic for visible lesions. Cold-knife conization is too invasive without a biopsy diagnosis. Metronidazole gel treats bacterial vaginosis, not appropriate without evidence of this infection being the cause of the lesion.

A 42-Year-Old G4P4 Has Had Postcoital Bleeding for the Past