Sixty five patients with benign ectopy of the uterine cervix were treated by cryosurgery in the departments of genitourinary medicine at St Luke's Hospital, Bradford, and the Airedale General Hospital, West Yorkshire, without analgesia or anaesthesia. A symptomatic cure rate of 98/o was achieved. There were no serious complications. This treatment is considered to be appropriate in genitourinary clinics in the United Kingdom as these have routine screening procedures for various genital infections.

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Case reportThe cervical smear of a 28 year old nulliparous woman showed inflammation together with ova of Schistosoma haematobium (Fig. 1). Eighteen months earlier she had returned from a two year backpacking trip in Africa. She had visited Kenya, Uganda and Malawi. Four days had been spent on Lake Malawi swimming three times a day. She was asymptomatic. In particular, there had been no vaginal discharge, intermenstrual bleeding, postcoital bleeding, dyspareunia, urinary frequency or haematuria. She could not recollect having had pruritis or a fever during the five weeks following her African adventures.Abdominal and pelvic examinations were normal. Colposcopy showed numerous, cream-coloured, 2 4 mm diameter nodules within the squamous and metaplastic epithelium of the ectocervix. All the visible columnar epithelium was normal. Following the application of acetic acid, the nodules became relatively dark centrally with a surrounding pale halo (Fig. 2). The uptake of Schiller's iodine was reduced at these sites. There was also a small area of acetowhite epithelium showing mosaicism suggestive of high grade intraepithelial neoplasia. This area was well demarcated with iodine. No abnormalities were seen within vaginal or vulva1 skin.A punch biopsy taken from a cervical nodule contained many Schistosoma ova in the subepithelial stroma surrounded by a granulomatous reaction with multinucleate giant cells and eosinophils (Fig. 3). A worm pair was identified. A second biopsy confirmed the presence of grade 2 cervical intraepithelial neoplasia. No ova were found in two late morning urine specimens or in a sample of faeces. Her blood count was normal and her eosinophil count was not raised at 0 . 2 1~1 0~. A Schistosoma ELISA was positive at level 3. The Schistosoma infection was treated with a single 2 g dose of praziquantel. The intraepithelial neoplasia was managed by loop diathermy excision. No colposcopic abnormality was found at a six month follow up examination, but the Schistosoma ELISA was unchanged.

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