Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Gynae oncology & screening
Cervical screening (HPV)
HPV-primary screening programme
Overview
The NHS cervical screening programme uses HPV-PRIMARY testing: samples are tested for high-risk HPV first, with cytology only as a triage if HPV-positive. Ages 25–64 (3-yearly 25–49, 5-yearly 50–64).
Recognise
- HPV-negative → routine recall
- HPV-positive, cytology normal → repeat in 12 months
- HPV-positive with abnormal cytology → colposcopy
Red flags
- Symptomatic women (abnormal bleeding) are investigated regardless of screening — screening is for the asymptomatic
Differentials & how to tell them apart
Symptomatic cervical diseaseinvestigate by colposcopy, not a screening smear
Investigations
High-risk HPV test on the cervical sample → reflex cytology if HPV-positive. Colposcopy for HPV-positive + abnormal cytology (or persistent HPV).
Management
HPV-primary testing → colposcopy if HPV+ with abnormal cytology
- 1HPV-negative: routine recall (3-yearly 25–49; 5-yearly 50–64). HPV-positive + normal cytology: repeat at 12 months.Gate: HPV-positive with abnormal cytology (or persistent HPV at repeats) → refer to colposcopy
- 2CIN treated by LLETZ (large-loop excision of the transformation zone).
Colposcopy ± LLETZ — for CIN treatment (large-loop excision)
Key points
Key change to learn: HPV is tested FIRST (more sensitive), cytology only triages HPV-positive samples. Screening starts at 25, not before.
Monitor & prognosis
Recall intervals; test-of-cure after CIN treatment.
Highly effective at preventing cervical cancer.
Source: NHS Cervical Screening Programme