1. S MEAR TAKERS U PDATE 18 TH S EPTEMBER 2014 HPV testing Immunisation Smears in pregnancy Describing the cervix. Screening lesbian and bi-sexual women Conditions of the Vulva (if we have time)

2. S MEAR T AKERS U PDATE S EPTEMBER 2014 CNS Alison Carlin

3. HPV T ESTING Test of cure. Within 3 years of treatment. Getting women back on to 3 yearly screening after historical HG disease.

4. HPV T EST OF C URE Colposcopy Treatment within the last 3 years. Colposcopy Treatment for high grade disease Colposcopy follow-up with cytology at 6-12 months Cytology and HrHPV test at 12 months post treatment Colp clinic Smear taker

5. HrHPV negative Cytology negative Repeat cytology and HrHPV in 12 months HrHPV negative Cytology negative Return to 3 yearly screening Smear taker

6. HrHPV negative Cytology positive HrHPV positive Cytology negative HrHPV positive Cytology positive Refer back to colposcopy

8. H R HPV TESTING OF WOMEN WITH A HIGH GRADE LESION MORE THAN 3 YEARS PREVIOUSLY WITH SUBSEQUENT REPEATED NEGATIVE CYTOLOGY TESTS ( HISTORICAL TESTING ) Cytology negative HrHPV negative Repeat both in 12 months Cytology negative HrHPV negative Return to 3 yearly screening Cytology negative HrHPV positive Annual cytology and HrHPV until 2 consecutive negative tests Return to 3 yearly screening

10. HPV IS ASSOCIATED WITH: >95% of clinical papillomata 99.7% of cervical cancers 85% of anal cancers 50% of vulval, vaginal and penile cancers 20% of oropharyngeal cancers 10% of cancers of larynx

12. I MMUNISATION N EWS New vaccines are being developed Nonavalant Vaccine – multiple HPVs 6/11/16/18/31/33/45/52/58 A Pan-HPV vaccine Therapeutic Vaccines 2 Dose vaccines

13. I MMUNISATION N EWS Australia finding a drop off in screening smears for the immunised 20-24, 25-29 groups 10% under 25s in a Facebook survey thought that if they were vaccinated they didn’t need cervical smears. Women up to 45-55yrs may benefit from vaccination but they will have to pay. Offering HPV vaccine to women treated for HSIL

15. S MEAR TAKING IN PREGNANCY Cervical cancer in pregnancy is rare 1 in 2,220 -1 in 4,000 Taking a smear in pregnancy is safe. Women should be screened as recommended by the program If the woman has never been screened then take a smear The cervix looks very different in pregnancy Make sure that the cytologists know the smear is from a pregnant woman There may be false positives and negatives due to pregnancy changes