Impact of Human Papillomavirus Primary Cervical Screening on Referral Rates and Outcomes for People Referred to Colposcopy for Clinical Reasons.

Authors

Adibah Khan, Katyana Gullery, Georgina Barber, Judy Ormandy

Published in

The Australian & New Zealand journal of obstetrics & gynaecology. Volume 66. Issue 5. Pages e70184.

Abstract

Colposcopy is most commonly indicated for people with screen-positive cervical screening tests. However, clinical reasons such as post-coital bleeding (PCB) or an abnormal appearing cervix can also prompt referral. Aotearoa New Zealand (AoNZ) transitioned from a cytology-based to an HPV-based cervical screening programme in September 2023.
To assess the incidence of high-grade or malignant pathology in people seen in Capital & Coast colposcopy clinic for clinical reasons and to evaluate the impact of HPV-based primary screening on these referral patterns and outcomes.
A retrospective review was undertaken of individuals referred to Capital & Coast colposcopy services for clinical indications. Two cohorts were analysed: Cohort 1 (June 2021-June 2023), during cytology-based screening and Cohort 2 (November 2023-November 2025), following implementation of HPV-based screening. Clinical outcomes were obtained from hospital databases.
Referrals for clinical reasons decreased significantly following the introduction of HPV screening, from 494/1699 (29%) in Cohort 1 to 252/2809 (9%) in Cohort 2 (p < 0.01). High-grade or malignant pathology was detected less frequently in Cohort 2 (0/252 (0%) vs. 7/494 (1.4%)), although this was not statistically significant (p = 0.10).
Referrals to colposcopy for clinical reasons decreased substantially following the introduction of HPV-based primary screening, with no high-grade or malignant pathology detected among those referred in Cohort 2 who did not meet screening-based referral criteria. While reassuring, HPV testing does not detect all cervical disease. Clinical assessment remains important for persistent or concerning symptoms or abnormal cervical findings, including consideration of HPV-independent disease.

PMID:
42830662
Bibliographic data and abstract were imported from PubMed on 05 Oct 2026.

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