Abstract
ABSTRACT
Colposcopy is most commonly indicated for people with screen‐positive cervical screening tests. However, clinical reasons such as post‐coital bleeding (PCB) or an abnormal appearing cervix can also prompt referral. Aotearoa New Zealand (AoNZ) transitioned from a cytology‐based to an HPV‐based cervical screening programme in September 2023.
Aim
To assess the incidence of high‐grade or malignant pathology in people seen in Capital & Coast colposcopy clinic for clinical reasons and to evaluate the impact of HPV‐based primary screening on these referral patterns and outcomes.
Methods
A retrospective review was undertaken of individuals referred to Capital & Coast colposcopy services for clinical indications. Two cohorts were analysed: Cohort 1 (June 2021–June 2023), during cytology‐based screening and Cohort 2 (November 2023–November 2025), following implementation of HPV‐based screening. Clinical outcomes were obtained from hospital databases.
Results
Referrals for clinical reasons decreased significantly following the introduction of HPV screening, from 494/1699 (29%) in Cohort 1 to 252/2809 (9%) in Cohort 2 (
p
p
= 0.10).
Conclusion
Referrals to colposcopy for clinical reasons decreased substantially following the introduction of HPV‐based primary screening, with no high‐grade or malignant pathology detected among those referred in Cohort 2 who did not meet screening‐based referral criteria. While reassuring, HPV testing does not detect all cervical disease. Clinical assessment remains important for persistent or concerning symptoms or abnormal cervical findings, including consideration of HPV‐independent disease.