Human papillomavirus (HPV) infection is the principal cause of cervical cancer. Clinical trials with HPV vaccines have shown high efficacy against HPV-induced precancerous cervical lesions. Before implementing a vaccination programme, up-to-date data on cervical dyskaryosis, incidence and annual treatment costs are needed. We assessed resource use and costs for 12 months following diagnosis for women with abnormal Pap smears in Germany based on a sample of 138 women who had received abnormal results on Pap smears taken during March and April of 2004. Most women had a Pap IIID (57%) vs Pap III (20%) or Pap IV (23%). Women with a Pap IV consulted their gynaecologist more frequently than those with a Pap III or Pap IIID (5.6 visits vs 4.2 and 4.6 visits, respectively). Only 9% of patients underwent colposcopy plus biopsy; this may be due to the lack of histological assessment by coloposcopy and biopsy done currently in Germany. More women in the Pap IV group had a cold knife conisation, compared with those in the Pap IIID group, (84% vs 27%) hysterectomy (22% vs 4%) and laser coagulation (12.5% vs 4%). Median treatment duration was shorter for women with a Pap III than for those with Pap IIID and IV (3 vs 5 months, respectively). Overall, 28.3% of the women were hospitalised (median 5; range 1-33 days). The estimated average annual cost per patient was Euro 1,055, Euro 943 and Euro 3,174 for Pap III, IIID and IV, respectively. The cost of managing precancerous cervical lesions in Germany was shown to be high.