HOW TO TREAT 25 urine and blood samples for her STI check and uses the opportunity to have a conversation about the new collection method for cervical screening .
NEW
Drug Directory
Access TGA-approved drug information , samples , patient resources and more
HOW TO TREAT 25 urine and blood samples for her STI check and uses the opportunity to have a conversation about the new collection method for cervical screening .
The doctor explains that all people with a cervix need to have cervical screening tests ( CST ) and that now it can be done by self-collection with a low vaginal swab .
The GP also explains that , as an under-screened woman , Roma may have a higher chance , ( about 1 in 10 ), of testing positive for HPV . If this is the case she will need to have further testing , either a colposcopy for the more high-risk types , or a cytology sample if it is an intermediate-risk type .
Roma agrees to give it a try . The GP gives her a red-topped flocked swab provided by the pathology laboratory , a small instruction sheet and advises that it is easier than inserting a tampon . Roma takes a sample in the doctor ’ s office , behind the curtain around the examination bed .
The test comes back as negative for HPV with a recommendation for a repeat sample in five years ’ time . The STI tests are also negative .
Case study two
JAYA , a 40-year-old-woman , makes an appointment to see her GP . She has been attending the practice for some years and has just received a reminder letter from the NCSR that she is due for her five-year cervical screening test .
Her GP performed an HPV test at the start of the new program and it was negative for HPV . Jaya had also previously had a Pap smear , which was negative .
Jaya is married , has two children and works part-time as a computer analyst . Her only medication is the contraceptive pill . She is otherwise well and has no history of note . The GP explains that there is a new collection method now approved for all people , where she can take a sample herself from the lower vagina without needing a speculum examination .
There is an 8-10 % chance that her CST will be positive , in which case she will need to have further investigation depending on the subtype of HPV , if detected . Jaya agrees that this sounds like a good option and goes ahead with it .
The GP gives Jaya a flocked swab
HPV not detected
Routine 5 – yearly screening
HPV not detected
Routine 5 – yearly screening
Routine 5 – yearly screening
Unsatisfactory LBC
Retest LBC only in 6 – 12 weeks
Unsatisfactory LBC
Retest LBC only in 6 – 12 weeks
HPV not detected
Figure 7 . Routine cervical screening .
and she goes behind the curtain around the examination bed and takes a sample . This swab is sent off to the pathology laboratory .
The result returns as positive for non16 / 18 which means that Jaya requires a recall for a cervical cytology sample . Her management pathway will depend on the result of that sample .
Jaya returns to her GP , who explains the situation . A cervical sample is taken , placed into a liquid-base cytology sample jar and returned to the laboratory for processing .
The cytology shows no evidence of any abnormality . The recommendation is for Jaya to return in 12 months for a repeat HPV test , which can also be self-collected .
When Jaya returns in 12 months she elects to have the clinician collect a sample straight away as the inconvenience of having to return is of concern to her .
The sample is reported by the
HPV ( not 16 / 18 ) detected
LBC ( reflex or clinician-collected cervical sample if self-collection was used )
LBC negative / pLSIL / LSIL
Repeat HPV test in 12 months
ONCOGENIC HPV TEST WITH PARTIAL GENOTYPING
HPV ( not 16 / 18 ) detected
LBC ( reflex or clinician-collected cervical sample if self-collection was used )
Negative
Repeat HPV test in 12 months pLSIL / LSIL
Direct referral to colposcopy is recommended for : – Patients 50 + years – Patients who identify as Aboriginal and / or
Torres Strait Islander
– Patients overdue for screening by at least 2 years at initial screen
LBC pHSIL or worse *
HPV detected ( any type )
Figure 8 . Self-collecting device .
LBC ( reflex or collect at colposcopy )
LBC pHSIL or worse *
HPV 16 / 18 detected
LBC ( reflex or collect at colposcopy )
Any LBC result or unsatisfactory
Refer for colposcopic assessment
HPV 16 / 18 detected
LBC ( reflex or collect at colposcopy )
Any LBC result or unsatisfactory
Refer for colposcopic assessment
Unsatisfactory LBC
Retest HPV in 6 – 12 weeks
Unsatisfactory HPV test
Retest HPV in 6 – 12 weeks
Risk of cervical cancer precursors
Low
Intermediate
Higher
* Includes pHSIL , HSIL , cancer or glandular abnormality
Adapted from : National Cervical Screening Program : Guidelines for the management of screen-detected abnormalities , screening in specific populations and investigations of abnormal vaginal bleeding . Cancer Council Australia , Sydney ( 2016 ). Updated July 2022
Figure 9 . Screening HPV test positivity , by oncogenic HPV type and age , 2021 . Source : AIHW National Cervical Screening Program monitoring report 2022 5