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

UNLABELLED: 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.

AIM: 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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.