Pathway for routine cervical

Order a CST ONCOGENIC HPV TEST WITH PARTIAL GENOTYPING (HPV)– routine

HPV HPV HPV not (not 16/18) 16/18 Unsatisfactory detected detected detected HPV test

REFLEX LBC REFLEX LBC Risk of precursors

Low Unsatisfactory Negative pLSIL/LSIL pHSIL/HSIL Any LBC LBC result Intermediate

Higher REPEAT HPV TEST IN 12 MONTHS Order an HPV test – follow-up

HPV HPV not detected detected (any type)

REFLEX LBC

Routine Retest for Routine Refer for Retest HPV Refer for 5-yearly LBC only in 5-yearly colposcopic in 6–12 colposcopic assessment screening 6–12 weeks screening assessment weeks

Adapted from: National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigations of abnormal bleeding. Cancer Council Australia, Sydney (2016) Investigation of women with abnormal vaginal bleeding

WOMEN WITH ABNORMAL VAGINAL BLEEDING

Consider sexual health Unexplained Post-coital Post-menopausal history & perform intermenstrual bleeding (PCB) bleeding appropriate tests bleeding

Order a Co-test (HPV+LBC) and please provide Order a Co-test CO-TEST (HPV+LBC) clinical notes CO-TEST (HPV+LBC) (HPV+LBC) and please provide clinical notes

HPV not HPV detected detected & (any type) &/or negative LBC abnormal LBC Refer for gynaecological assessment result (regardless of test result)*

Refer for Single Recurrent or gynaecological episode PCB persistent PCB assessment (Pre-menopausal (any age)# (regardless of women) test result)*

Clinically normal

No required (advise to Refer for see healthcare gynaecological * May include colposcopy professional if assessment* # If significant delay (3–6 months from the previous test) symptoms persist) following original HPV/LBC test, a repeat LBC could be considered K057

Details correct November 2017