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Abnormal cervical screening / cervical dysplasia / abnormal cervix

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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

 

  • Refer to local Healthpathways or local guidelines
  • Women who are in follow-up for pLSIL/LSIL cytology in the previous program (pre-renewal NCSP) should have a HPV test at their next scheduled follow-up appointment.
    • If oncogenic HPV is not detected, the women can return to 5-yearly screening
    • If any HPV is detected, the woman should be referred for colposcopic assessment
  • 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 +/- liquid cytology 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

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Invasive cancer (squamous, glandular, other). For optimum care, patient should be seen by gynaecological oncology within 2 weeks.
    • LBC of PHSIL/HSIL
    • AIS or possible high grade glandular lesion
    • Positive HPV 16/18 and
      • unsatisfactory LBC
      • previous treatment for PHSIL/HSIL
      • past history of positive HPV 16/18
      • Atypical glandular cells/endocervical cells of undetermined significance
      • unknown cytology
    • Positive HPV non-16/18 and
      • 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
        • on 3 consecutive yearly tests or
        • in a person who is:
          • 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
      • women aged 70+
      • immune deficient women
      • women currently undergoing Test of Cure following treatment of histological HSIL
    • HPV other
    • 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 – 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
    • Any abnormal result and past history of excisional treatment of AIS

  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

 

2. Essential referral information 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
    • immunosuppressive therapy
  • Medical management to date
  • Most recent and current cervical screening results (LBC should be performed on any sample with positive oncogenic HPV)

3. Additional referral information Useful for processing the referral

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

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

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

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

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.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

     

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

     

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Version: 25
Last updated: 10 January 2023

© State of Queensland (Queensland Health) 2023

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au.

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