Skip links and keyboard navigation

health.qld.gov.au
Contact us

Abnormal cervical screening / cervical dysplasia / abnormal cervix

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • Refer to local HealthPathways or local guidelines
  • A single Cervical Screening Test may be considered for women between the ages of 20 and 24 years who experienced their first sexual activity at a young age (e.g., before 14 years) or who had not received the HPV vaccine before sexual activity commenced.
  • Adolescent patients with abnormal HPV should follow the same pathway as adult patients. Patients <25 years old should also have screening for STI as they are a high-risk group.
  • Consider using oestrogen cream in post-menopausal patients
  • Patients with positive non-16/18 but normal or LSIL on LBC would not need referral and only a repeat CST in 12 months.  
  • Recall women in 6-12 weeks if they have an unsatisfactory screening report
  • Specific efforts should be made to provide screening for Aboriginal and Torres Strait Islander women.  They should be invited and encouraged to participate in the NCSP and have a 5-yearly HPV test, as recommended for all Australian women.
  • Women who have been treated for HSIL (CIN2/3) do not need a post-treatment colposcopy. These women should have a co-test (HPV and LBC test) performed at 12 months after treatment, and annually thereafter, until she receives a negative co-test on two consecutive occasions, when she can return to routine 5 yearly screening. This is called ‘test of cure’.
  • If, at any time post treatment, the woman has a positive oncogenic HPV (16/18) test result, she should be referred for colposcopic assessment (regardless of the reflex LBC result).
  • If, at any time during Test of Cure, the woman has a LBC prediction of pHSIL/HSIL or any glandular abnormality, irrespective of HPV status, she should be referred for colposcopic assessment.

Clinical Resources

National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.

​

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Invasive cancer (Squamous, glandular, other). For optimum care, patient should be seen by gynaecological oncology (National guidelines suggests being seen at the earliest opportunity for urgent
    evaluation).
  •  LBC of PHSIL/HSIL
  • Positive HPV 16/18 and
    • Unknown cytology
    • Unsatisfactory LBC
    • Previous treatment for PHSIL/HSIL(National guidelines suggests being seen at the earliest opportunity, ideally within 8 weeks).
    • Past history of positive HPV 16/18(National guidelines suggests being seen at the earliest opportunity, ideally within 8 weeks).

Glandular lesions

  • AIS or possible high grade glandular lesion
  • any atypical glandular cells/endocervical cells of undetermined significance
Category 2
(appointment within 90 calendar days)
  • Positive HPV 16/18 and
  • normal LBC
  • PLSIL/LSIL
  • Positive HPV non 16/18 and
  • Persistent positive non 16/18 HPV or HPV other
  • on 3 consecutive yearly tests 
  • on 2 consecutive test
    • two or more years overdue for screening at the
    • time of the initial screen
    • identifies as Aboriginal or Torres Strait islander
    • aged 50-69 years
  • on a single test
    • women aged 70+
    • immune deficient women
    • women currently undergoing Test of Cure following
    • treatment of histological HSIL
  • History of diethylstilboestrol (DES) exposure in utero regardless of HPV status or LBC test
  • Abnormal appearing cervix with normal cervical screening
  • Recurrent post-coital bleeding in pre-menopausal woman after STIexcluded/treated – gynaecological assessment recommended
  • Any episode of unexplained vaginal bleeding (including post-coital) in a post-menopausal woman
  • Unexplained persistent unusual vaginal discharge, especially if offensive and blood stained and after STI excluded/treated
  • Any abnormal result and past history of excisional treatment of AIS
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Abnormal cervical screening / cervical dysplasia / abnormal cervix referrals (Referral will be returned without this)

  • History of
    • Any abnormal bleeding (i.e. post-coital and intermenstrual)
    • Unexplained persistent deep dyspareunia or unexplained persistent unusual vaginal discharge
    • Previous abnormal cervical screening results and any treatment (results to be included in referral)
    • Immunosuppressive therapy
  • Medical management to date
  • Most recent or current cervical screening results (LBC should be performed on any sample with positive oncogenic HPV)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Abnormal cervical screening / cervical dysplasia / abnormal cervix referrals

  • BMI
  • HPV Vaccination history
  • STI screen result, endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • History of smoking

Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Acute urinary obstruction
  • Unstable molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 18 December 2023