HPV testing in the National Cervical Screening Program--when is it recommended?

Background: Women with high grade cervical squamous intraepithelial lesions (HSILs) have traditionally had annual smears after treatment. This recommendation however, changed in 2005. Since then, testing for high risk types of human papillomavirus (HPV) has been an integral part of the follow up of these women. Despite this, health practitioners are failing to perform HPV tests on all women eligible for testing.

Objective: This article highlights the recommendation for HPV testing after treatment of HSILs. By testing appropriately, a significant number of these women will be able to return to routine cervical screening.

Discussion: Persistent infection with high risk HPV types is known to cause high grade cervical changes which, if left untreated, can progress to cervical cancer. Following treatment, high grade changes have been shown to regress in the majority of women and ongoing risk can be assessed using HPV testing. Cervical cytology accompanied by HPV testing should commence 12 months after treatment, and continue annually until the woman has tested negative for both tests on two consecutive occasions. When all four tests are negative, the woman can safely return to the recommended routine Pap screening interval (currently 2-yearly).