Cervical Screening

Who’s eligible

Anyone with a cervix aged 25–74 who has ever had any sexual contact (intercourse, oral sex, intimate skin-on-skin contact, anal sex) — regardless of HPV vaccination status, current sexual activity, relationship structure, or condom use (HPV spreads via skin contact a condom doesn’t cover). Screen every 5 years if HPV-negative.

That includes trans men and non-binary people with a cervix, who are often missed. Self-collection, the smallest speculum or self-insertion can make the test easier. See Gender Dysphoria.

The test

Primary HPV test with partial genotyping (HPV 16/18 vs other oncogenic types), either:

• Self-collected vaginal swab — now a fully equal, universally available option for anyone eligible (except when a co-test is specifically indicated, see below); or
• Clinician-collected cervical sample — allows reflex liquid-based cytology (LBC) on the same sample if HPV is detected.

Self-collection is exactly as accurate as clinician-collection for detecting HPV and CIN2+. If HPV is detected on a self-collected sample and cytology is needed, the patient returns for a clinician-collected LBC sample (as soon as practical, ideally within 6 weeks) — or, if going straight to colposcopy, the LBC sample is taken there instead, without a separate visit.

Who needs a co-test instead (not eligible for self-collection)

• Symptoms suggestive of cervical cancer: unexplained postcoital bleeding, persistent intermenstrual or postmenopausal bleeding, unexplained persistent unusual vaginal discharge, or an abnormal-looking cervix
• Treated for adenocarcinoma in situ (AIS)
• DES exposure in utero

Co-testing/colposcopy referral is not needed for bleeding clearly attributable to hormonal contraception, sample-collection contact, heavy-but-regular periods, or an STI.

Results pathway

Result	Action
HPV not detected	Routine 5-yearly screening
HPV 16/18 detected	Direct colposcopy referral regardless of LBC result
HPV (not 16/18), LBC negative/pLSIL/LSIL	Follow-up HPV test at 12 months
HPV (not 16/18), LBC pHSIL/HSIL/glandular abnormality	Colposcopy referral
Unsatisfactory HPV	Repeat ASAP, ideally within 6 weeks

At the 12-month follow-up: HPV not detected → return to routine screening. HPV 16/18 → colposcopy. HPV (not 16/18) → repeat LBC; if still negative/LSIL, a further follow-up HPV test at 24 months; if that’s also HPV-negative, return to routine screening — if HPV is still detected at 24 months, colposcopy regardless of type.

Direct-to-colposcopy exception at the 12-month follow-up (skip the repeat-LBC step, go straight to colposcopy if HPV any type is detected, regardless of LBC result) applies if the patient:

• Was overdue for screening by ≥2 years at the time of the original positive test, or
• Identifies as Aboriginal and/or Torres Strait Islander, or
• Is aged ≥50

Special groups

Immune-deficient (HIV, solid organ transplant, congenital immune deficiency, immunosuppressant therapy for autoimmune disease, GVHD post-BMT): 3-yearly screening; any oncogenic HPV type detected → direct colposcopy referral.

DES-exposed in utero: annual co-test + colposcopic exam of cervix/vagina, indefinitely.

Pregnant: screen at any stage of antenatal care if due/overdue — spotting after the procedure is expected, harmless, and self-limiting. Use a broom-type brush, not an endocervical brush/cytobrush (bleeding risk). Self-collection is fine at any point in pregnancy — check the swab is validated for use in pregnancy with your lab. Can defer to the postnatal visit if preferred.

Vaginal/cervical atrophy: if a previous smear was atrophic, or the patient has postmenopausal vaginal atrophy, consider 2 weeks of vaginal oestrogen first — stop 2 nights before the test.

Aged 70–74 (exit test) or ≥75 requesting screening (never screened, or none in the last 5 years): HPV not detected → exit the program; any HPV type detected → direct colposcopy referral regardless of LBC result.

After hysterectomy

Scenario	Follow-up
Subtotal (cervix remains)	5-yearly HPV test as usual
Total, normal prior screening, no pathology at hysterectomy	No further surveillance
Total, treated for histologically-confirmed HSIL with completed Test of Cure, no pathology at hysterectomy	No further surveillance
Total, HSIL found at hysterectomy / incomplete Test of Cure / unknown or never screened	Annual HPV test (vaginal vault) from 12 months post-op, until 2 consecutive negatives → then stop
Total, AIS history	Annual co-test (vaginal vault) from 12 months post-op, until 2 consecutive negatives → then stop

Test of Cure after HSIL (CIN2/3) treatment — changed 2025

Now HPV-only testing (not co-testing), starting 12 months post-treatment: annual HPV tests until 2 consecutive HPV-not-detected results, then return to routine 5-yearly screening. Co-testing is reserved for a case-by-case decision only where excision margins were positive. (Patients partway through the old co-test-based pathway before 1 July 2024 can complete it via a second 12-month HPV-only test.)

AIS surveillance after treatment — changed 2025

No longer indefinite annual co-testing. Now: annual co-testing for 5 years; if all negative, extend to 3-yearly; after 25 years of negative surveillance, patients <70 return to routine screening, and patients ≥70 can exit entirely (provided at least one co-test since turning 70 was HPV-negative and LBC-negative).

Practical notes

• Avoid carbomer-containing lubricant (excessive amounts can interfere with testing); carbomer-free options include medical-grade KY Jelly, Surgigel, Astroglide.
• STI screening (chlamydia, gonorrhoea, trichomonas, M. genitalium) can be co-collected in the same liquid-based medium if indicated by risk.
• The NCSR no longer honours “not for register” instructions on pathology forms — patients who want to opt out must do so via the NCSR Participant Portal or Healthcare Provider Portal, not by a form annotation.