Cervical Screening in Aotearoa

❍ At a glance

• New Zealand moved to primary HPV-based cervical screening in 2023. Eligible people are those with a cervix aged 25-69, regardless of sexual history or HPV vaccination status. Screening interval is every 5 years for most people - longer than the old cytology programme, with improved detection of significant disease.¹
• HPV 16/18 detected with any cytology abnormality: refer to colposcopy. HPV 16/18 detected with negative cytology: still refer to colposcopy within 3 months (high-risk combination regardless of cytology). Other high-risk HPV with negative cytology: repeat combined test in 12 months.
• Self-testing is now a formal part of the NZ programme. Offer it proactively to Maori and Pacific women and others with barriers to clinician-collected testing. Sensitivity for HPV detection is similar to clinician-collected samples.³
• Postcoital bleeding always warrants cervical examination, regardless of screening history. A normal HPV screen does not exclude a visible cervical lesion. Refer urgently if a visible abnormality is present.

❍ Programme pathway and result interpretation

Eligibility: any person with a cervix aged 25-69, free, regardless of sexual history or vaccination status. People who have never been sexually active can be offered screening - shared decision-making is appropriate given very low HPV exposure risk. Vaccinated people should still screen.

Test: clinician-collected cervical sample or self-collected vaginal swab, tested for high-risk HPV. Reflex cytology is performed on the same sample if high-risk HPV is detected.

Results: HPV not detected - return to routine 5-yearly screening. HPV 16 or 18 detected with any cytology abnormality - refer to colposcopy. HPV 16 or 18 detected with negative or inadequate cytology - refer to colposcopy within 3 months (these types carry high risk regardless of cytology). Other high-risk HPV detected with any cytology abnormality - refer to colposcopy. Other high-risk HPV with negative cytology - repeat combined test in 12 months; if HPV still detected, refer to colposcopy; if negative, return to routine 5-yearly screening. Inadequate sample - repeat within 3 months.

Self-testing: appropriate for people who decline clinician-collected testing due to discomfort, cultural reasons, previous trauma, or access barriers. Similar HPV sensitivity to clinician-collected tests. Offer proactively to Maori and Pacific women - this is a deliberate equity tool. Offering self-testing in a culturally safe, non-judgmental way is as important as the technical aspects.

Colposcopy: specialist examination of the transformation zone with targeted biopsies. In NZ, provided through DHB/hospital gynaecology. Most referrals seen within 4-8 weeks; urgent referrals within 2 weeks. CIN 2/3 is typically treated by LLETZ. CIN 1 is managed conservatively. After treatment: enhanced surveillance with combined HPV and cytology at defined intervals before return to routine screening.

❍ HPV vaccination and referral criteria

Gardasil 9 is funded for people aged 9-26 under the NZ immunisation schedule, covering HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Surveillance data from vaccinated NZ cohorts shows significant reductions in CIN 2/3 incidence. Catch-up for ages 27-45 is available but not funded.

Urgent colposcopy (within 2 weeks): visible cervical lesion suspicious for invasive cancer; persistent unexplained postcoital bleeding with abnormal-appearing cervix. Routine colposcopy: as per HPV pathway above. Postcoital bleeding always requires cervical examination - a normal HPV screen does not exclude ectropion, cervicitis, or visible lesion. Check local HealthPathways for current colposcopy referral thresholds and wait times.