Table 2.

Panelists’ in-depth responses on their cervical atypia practice from, round 1.

Panelist	Question 1: Current clinical practices?	Question 2: Other information you would like to share?
1	I follow ACOG guidelines for evaluation and follow-up. If cervical HPV only, I use regimens that include green tea suppositories, vitamin A suppositories, folic acid, DIM, selenium, carotenoids, and green tea.	If the patient has CIN, I determine when they might need cryo, LEEP, cold knife cone, or the supplements and suppositories above along with an herbal escharotic treatment.
2	Immune support with nutritional and herbal supplements, dietary and lifestyle changes, and if appropriate a topical escharotic treatment directly to the cervix.	It is critical to the success of HPV management to treat the whole body, not just the abnormal cervical cells associated with HPV infection.
3	When a patient presents with a diagnosis of high grade HPV I would take a thorough current medical history including recent pap results, pathology, treatments, sexual history, motivation for seeking naturopathic treatment, medication and supplements currently used, past medical history, family medical history, and social history. I follow conventional guidelines of ASCCP for testing and for referral for colposcopy. If the patient has had an abnormal pap, ASCUS, LGSIL, HGSIL, etc., I would refer for colposcopy and biopsy. Often the patient is referred to me for adjunctive care by their health care provider after they have had colposcopy. The suggested treatment is based on their pathology and previous treatment.	I used the following basic plan and vary it based on the patient’s individual situation: Vaginal suppositories: Calendula/Vitamin A suppositories for 6 nights alternating with herbal suppositories that contain Hydrastis, Commiphora, Echinacea, Usnea, Althea, Geranium and Achilliea suppository for 6 nights. In between the two types of suppositories, I have the patient take one night without a suppository. Oral botanical formula: Taraxacum root, glycyrrhiza root, hydrastis and trifolium or ligusticum. Dose: one half teaspoon. Vitamin C 3000 mg PO qd. Folic acid 2 gms PO qd. Green tea: 12–16 oz per day or green tea capsules. Adequate vitamin D to maintain a vitamin D level between 40–60 ng/mL. If a patient only has high grade HPV and normal pap smear, I will recommend the following until the next pap: If next pap is normal continue oral supplements until following pap. Vitamin C 3000 mg PO qd. Folic acid 2 gms PO qd. Green tea: 12–16 oz per day or green tea capsules. Adequate vitamin D to maintain.
4	I follow the guidelines as per ASCCP regarding management of abnormal cytology and histology. Care and treatment of the effect of HPV in terms of dysplasia depends of the extent of the dysplasia and how it is affecting the cervix.	ASCUS + HR HPV +, LSIL, HSIL, CIS I refer all these patients for colposcopy. CIN I and CIN II, I may treat with folic acid, DIM and or green tea suppositories if there is a negative ECC. CIN III, I refer for LEEP.
5	Follow ACCN guidelines for testing. Use topical products including green tea, Vit. A and thuja suppositories. Use TCA, Aldara for topical condyloma. Use oral supportive nutrients such as green tea, folic acid, carotenes, DIM/calcium-d-glucarate, zinc. Refer for escharotic treatment or LEEP as appropriate and following patient preferences/insurance coverage.	Limited patient numbers for HPV management.
6	If a patient is HPV high risk positive, I run genotyping with MDL to determine the specific high risk strain. If it is 16 or 18, I am more aggressive in my treatment than if it is not 16 or 18. I start with a 3 month oral protocol consisting of; Folic acid 10 mg/day Beta carotene 180,000 IU/day B12 2,500 mcg/day Vitamin C 3–4 grams/day Anti-viral herbal tincture (echinacea, ligusticum, lomatium, licorice, and thuja) Green tea extract 1,650 mg/day Indole-3-carbinol 400 mg/day Coriolus versicolor 3,000 mg/day Plus a one month herbal suppository protocol of; week one—a suppository containing Myrrh, echinacea, goldenseal, marshmallow, geranium, and yarrow. Week two—green tea compounded suppository. Week three—repeat week one. Week four—repeat week two.	This is a very successful protocol for HPV high risk alone or with cervical dysplasia including ASC-US, CIN I and CIN II. If it is CIN III the treatment is a little different. I don’t use suppositories and instead do 8 escharotic treatments to the cervix. Obviously this includes proper work-up and following ACOG guidelines for colposcopy.