Practice tips
Testing in the presence of symptoms
Screening tests are for people who are asymptomatic. Where there are clinical symptoms (Bleeding - intermenstrual, post coital, post menopause pain or discharge) an LBC for co-testing with both HPV and cytology is often appropriate as part of the clinical assessment. Inappropriate co-testing however is discouraged as it can use valuable health resources, so laboratories have been provided with the following instructions:
LBC samples: Accept requests for co-testing if the following symptoms/signs are recorded on the laboratory request form:
1. Abnormal vaginal bleeding of any type
2. An abnormal appearance of the cervix or vagina
3. Pelvic Pain
4. Vaginal discharge
LBC samples: Decline cytology testing if co-testing has been requested and the HPV result is Not Detected, if the request form states:
1.“Clinically indicated”
2. “Symptoms” (not otherwise specified)
3. Friable cervix
4. Contact bleeding
Where the HPV result is Detected,the laboratory will process cytology or refer the participant for specialist assessment according to the NCSP Clinical Practice Guidelines
Cytology will not be processed for an asymptomatic person (no symptoms or signs recorded on the request form) if the HPV result is Not Detected
LBC samples are kept for one month so if a referrer omitted to write the indication for co-testing on the form and only an HPV test is processed, the referrer can ring the laboratory to provide the reason for requesting co-testing,and the laboratory will then process the cytology
Swab samples: Participants will be recalled for cytology if the result is HPV Not Detected and the following is recorded on the request form:
Abnormal vaginal bleeding, any type.
An abnormal appearance of the cervix or vagina
If co-testing is required, please SUBMIT AN LBC SAMPLE ONLY. Both HPV and cytology can be processed from an LBC sample. Don’t send a vaginal swab as well– it isn’t required and will be discarded at the laboratory if both an LBC and swab sample are sent.
Anyone with symptoms should be fully clinically assessed, usually including a clinical examination. Co-testing is only one part of the assessment, and negative results will not necessarily exclude significant cervical pathology.
Please refer to your local Health Pathways for advice regarding the assessment and management of those with symptoms.
Reporting a person’s hysterectomy status
Clinicians may be aware that some people have had a hysterectomy which is not recorded on the NCSP Register.
You can inform the NCSP Register about a person’s hysterectomy status using the updated form on the Health NZ – Te Whatu Ora website here.
If the hysterectomy is not recorded on the new NCSP Register, people maybe receiving notifications or appearing on the cervical screening status report as overdue for cervical screening. This could also be happening because they still require some screening or follow up even though they have had a hysterectomy.
Updating ethnicity
Please note for bowel, breast and cervical screening purposes the ethnicity must be updated on the NHI to update the screening registers. It is not sufficient to solely update on the Patient Management System as this does not automatically update NHI data. The process for updating NHI varies between PMS. Please consult your administration staff for assistance.
Please email ncsp@tewhatuora.govt.nz if you are aware of any similar situations among people you have screened, or if there are any other unexpected reactions you are aware of. This will enable the NCSP to continue its monitoring and update advice as required.
Recalls and Reminders
It’s important to continue to send recalls and reminders to your patients at a local level.
