HPV Testing

Question 1

What is the primary cervical screening test in NZ?

Answer 1

HPV testing
Replaced liquid based cytology

Question 2

Which test is more sensitive for cervical screening? HPV or LBC

Answer 2

HPV

Question 3

How does HPV testing work as cervical screening? What does it aim to detect?

Answer 3

Detects presence of DNA from types of HPV that are known to cause cervical cancer
This identifies people at risk for abnormal cell changes and require further testing

Question 4

Eligibility for cervical screening

Answer 4

People with cervix or vagina aged 25-69 who have ever been sexually active. Has also been extended to 70-74yo who are un- or under-screened.

Question 5

Cervical screening interval now _______ if “HPV not detected” result

Answer 5

5 yearly

Question 6

If immune deficient what is the cervical screening interval

Answer 6

If immune deficient → screen 3 yearly (indicate on lab form and NCSP register)

Question 7

Do you still need to do repeat test in 1 year if new to cervical screening?

Answer 7

Repeat test in 1 year is not needed after first ever test if HPV not detected

Question 8

Who is accredited to do cervical screening/HPV tests?

Answer 8

Only doctors and midwives or other healthcare professionals (e.g. nurses who have completed NZQA training in cervical screening) are accredited to do HPV testing

Question 9

For those accredited to do HPV testing what is the minimum number required per year to retain this status?

Answer 9

10 HPV tests

Question 10

Definition of unscreened

Answer 10

Never had cervical screening

Question 11

Definition of under-screened

Answer 11

No cytology test in the past 5 years or no HPV test in the past 7 years

Question 12

Eligibility for funded cervical screening

Answer 12

≥ 30yo who are unscreened or under-screened (incl 70-74yo)
Anyone requiring f/up or surveillance (e.g. for a test of cure); even if they were not eligible for funded screening for their initial test
Māori or Pacific aged 25 – 69 years
Community services card holder aged 25 – 69 years

Question 13

HPV testing can be performed from what types of samples?

Answer 13

Vaginal swab taken by patient (self-test)
Vaginal swab taken by clinician (cervical sample taker)
Liquid-based cytology

Question 14

What is tested if a liquid based cytology test is done? In routine screening

Answer 14

Will only be tested for HPV initially. If HPV detected reflex cytology will then be performed

Question 15

LBC sample for both HPV and cytology testing is required if…

Answer 15

Prev low grade result and not returned to regular screening
1-2yr f/up after a “HPV detected type other” result
People with immune deficiency (as should be referred for colposcopy if HPV of any type is detected)
If f/up is difficult

Question 16

HPV testing swabs should be stored at what temp prior to transport?

Answer 16

Room temp

Question 17

HPV testing swabs should be sent to lab ASAP but wet swabs may be able to be processed up to ______ after sampling and dry swabs up to ______

Answer 17

Wet - 2 weeks
Dry - 1 month

Question 18

Can exit the cervical screening programme when?

Answer 18

From 65yo (or 67yo if immune deficient) - if “HPV not detected” result and are not in f/up for abnormal cytology/histology

Question 19

When can 70-74yo exit the cervical screening programme (if un screened or under screened)

Answer 19

If 70-74yo and unscreened or under-screened prior to 70yo - should have HPV test and can exit programme once HPV is not detected

Question 20

What counts as under screened for 70-74yo?

Answer 20

Transitioning from cytology-based programme without 2 consecutive normal cytology results after 62yo

Already transitioned to new programme and not had a negative HPV test in 5 years prior to age 70 (or 3 years prior if immune deficient)

Question 21

Can HPV testing be done during menstruation?

Answer 21

Can be done during menstruation if necessary (although not preferable) - excessive blood on swab may cause invalid results and repeat test needed (funded)

Question 22

Can HPV testing be done during pregnancy/post partum?

Answer 22

Can be done during pregnancy and postpartum. Should still be referred colposcopy if required but biopsy may be delayed.

Question 23

What can you use if HPV testing is likely to be painful secondary to vaginal atrophy?

Answer 23

Vaginal oestrogen cream can be considered for vaginal atrophy if cervical screening likely to be painful (but swab cannot be taken if sample obscured by cream)

Question 24

Can you do STI testing on same swab as HPV testing?

Answer 24

STI testing must be done on a separate swab

Question 25

Does recent HPV vaccination affect results of HPV testing?

Answer 25

No

Question 26

Can you have HPV if you are not currently sexually active?

Answer 26

HPV can be latent and reactivate so can be detected even if not currently sexually active but has been in past

Question 27

Possible results from HPV testing

Answer 27

HPV not detected
HPV detected type 16
HPV detected type 18
HPV detected type other
Invalid (sample processed but no result)
Unsuitable for analysis (e.g. sample was leaking so not processed)

Question 28

How common is it for HPV type 16 or 18 to be detected?

Answer 28

~2.5% of results

Question 29

What should you do if HPV type 16 or 18 is detected?

Answer 29

Refer colposcopy

Question 30

How common is it for HPV type other to be detected?

Answer 30

~7.5% of results

Question 31

What should you do if HPV type other is detected?

Answer 31

LBC

Question 32

What should you do if HPV of any type detected in immune deficient pt

Answer 32

Colposcopy
(informed by cytology where possibly but should not delay referral)

Question 33

How common is it for result to be HPV not detected?

Answer 33

~90%

Question 34

What should you do if result is HPV not detected?

Answer 34

Screen again in 5yrs (3yrs if immune deficient)