Cervical Screening Explained

What the HPV test looks for, whether you can collect it yourself, and what your result actually means

For years, cervical screening meant having a Pap smear every two years.

That has changed.

Australia now uses a Cervical Screening Test that looks for human papillomavirus, or HPV, because persistent infection with certain types of HPV causes almost all cervical cancers.

For most people, screening is now needed only every five years. And you may not need a speculum examination at all.

Most eligible people can now choose to collect their own vaginal sample using a simple swab.

The most important message is:

Cervical screening is designed to find risk early, long before cervical cancer develops.

Who needs cervical screening?

Australia’s National Cervical Screening Program recommends routine screening if you:

• are aged 25 to 74
• have a cervix
• have ever been sexually active.

Routine screening is generally performed every five years when your previous HPV screening result was normal.

You still need screening if you:

• have had the HPV vaccine
• are no longer sexually active
• have only ever had one sexual partner
• have sex with women
• have been through menopause.

The important questions are whether you have a cervix, your age and your screening history.

Why don’t we call it a Pap smear anymore?

The old Pap smear looked mainly for abnormal cells on the cervix.

The current Cervical Screening Test looks first for HPV.

This is important because persistent infection with certain HPV types usually occurs before significant cervical cell changes develop.

Testing for HPV therefore allows us to identify people who may need closer follow-up earlier in the process.

Because HPV testing is more sensitive than the old Pap smear approach, people with a negative result can usually wait five years before their next routine test.

What is HPV?

HPV is an extremely common virus that spreads through intimate skin-to-skin and sexual contact.

HPV is very common, and many sexually active people are exposed to it at some stage.

Usually, the immune system clears the infection without the person ever knowing they had it.

A positive HPV test therefore does not mean you have cancer.

It does not even necessarily mean that you will develop abnormal cervical cells.

The concern is mainly when a high-risk HPV infection persists over time.

That persistent infection can eventually cause changes in cervical cells that, if left untreated, may progress to cancer.

Does having HPV mean my partner has been unfaithful?

No.

This is one of the most important misconceptions about HPV.

HPV can remain in the body at very low levels for years before becoming detectable.

A positive result cannot tell you:

• when you acquired HPV
• who you acquired it from
• how long it has been present.

A positive HPV result therefore does not provide evidence of recent infidelity.

This is a common virus, not a test of someone’s relationship history.

Can I collect the test myself?

Yes, in most routine screening situations.

All eligible cervical screening participants now have the option of self-collection.

Instead of having a clinician insert a speculum and take a sample directly from your cervix, you insert a small swab into your vagina and collect the sample yourself.

Your GP, nurse or other healthcare provider organises the test and explains how to collect it.

The swab is then sent to the laboratory to look for HPV.

Self-collected samples are just as effective at detecting HPV as clinician-collected cervical samples for routine screening.

What does self-collection actually involve?

It is usually straightforward.

You will generally be given:

• a small swab
• privacy
• instructions on how to insert and rotate the swab in the vagina
• a specimen tube or container.

You do not need to reach your cervix.

The sample is taken from the vagina.

You can usually collect it privately in the clinic bathroom or another suitable space.

If you are unsure, ask the clinician to explain the technique before you start.

Do I have to do self-collection?

No.

It is a choice.

Some people prefer self-collection because they:

• find speculum examinations uncomfortable
• have previously had a painful examination
• feel embarrassed
• have experienced sexual trauma
• have cultural or privacy concerns
• simply prefer more control over the process.

Others would rather have their doctor or nurse collect the sample.

Both are reasonable choices.

For routine HPV screening, either approach can be appropriate.

When might I still need a speculum examination?

Self-collection is excellent for routine HPV screening, but it does not replace every cervical examination.

A clinician-collected cervical sample may still be needed in some circumstances, including when additional cervical-cell testing is required after certain HPV results.

A speculum examination may also be necessary when you have symptoms that need examination rather than screening.

For example:

• bleeding after sex
• unexplained bleeding between periods
• new bleeding after menopause
• persistent unusual vaginal discharge
• unexplained pelvic symptoms.

These symptoms should not simply be dealt with by doing a routine screening swab.

The question is no longer just:

“Am I due for screening?”

It becomes:

“Why am I having this symptom?”

That may require an examination and other tests.

What does the laboratory look for?

The screening test looks for high-risk types of HPV associated with cervical cancer.

Two types, HPV 16 and HPV 18, are particularly important because they cause a large proportion of cervical cancers.

Other high-risk HPV types can also be detected.

What happens next depends on:

• whether HPV is detected
• which type is detected
• whether cell testing is needed
• your previous results
• your age and clinical circumstances.

That is why a positive result does not lead to exactly the same next step for everyone.

What does an HPV-negative result mean?

This is the most common and reassuring result.

It means high-risk HPV was not detected.

For someone in the routine screening program, the usual next step is another Cervical Screening Test in five years.

A negative test means your current risk of developing cervical cancer is very low.

It does not mean you can never develop HPV or cervical abnormalities in the future, which is why screening is repeated rather than stopped permanently.

What does an HPV-positive result mean?

It means a high-risk HPV type has been detected.

It does not mean you have cervical cancer.

Most HPV infections will not progress to cancer.

Depending on the HPV type and other findings, you may need:

• further testing on a clinician-collected sample
• repeat HPV testing after a specified interval
• referral for colposcopy.

Your GP will explain which pathway applies to your particular result.

The important point is:

HPV-positive means “we need to follow this up”, not “you have cancer”.

What is a colposcopy?

A colposcopy is a closer examination of the cervix performed by a clinician with specialised training.

A speculum is inserted so the cervix can be seen, and a magnifying instrument called a colposcope is used to examine it.

Small biopsies may be taken if an area looks abnormal.

A referral for colposcopy does not mean cervical cancer has been diagnosed.

The purpose is to identify significant cell changes so they can be monitored or treated before they become cancer.

What if abnormal cells are found?

Abnormal cervical cells are usually described according to how significant the changes appear.

Some low-grade abnormalities resolve without treatment, especially when HPV clears.

Higher-grade abnormalities may need treatment because they have a greater chance of progressing over time.

Treatment usually removes or destroys the abnormal area of the cervix.

This is one of the reasons screening works so well:

we can often treat precancerous changes rather than waiting for cancer to develop.

I’ve had the HPV vaccine. Do I still need screening?

Yes.

HPV vaccination greatly reduces the risk of cervical cancer, but it does not protect against every HPV type that can cause cancer.

People aged 25–74 with a cervix should therefore continue routine cervical screening even if they were fully vaccinated.

Vaccination and screening work together.

One reduces your chance of developing persistent high-risk HPV infection; the other detects important infections or changes that still occur.

Why does screening start at 25?

Routine cervical screening starts at 25 years in Australia.

HPV infection is very common in younger people and usually clears naturally.

Cervical cancer itself is rare under 25, and screening younger people has little or no proven impact on rates of invasive cervical cancer while increasing the chance of finding temporary abnormalities that would have resolved on their own.

That is why starting screening earlier is not automatically better.

However, symptoms such as unexplained bleeding still need assessment regardless of age.

What happens when I reach 70–74?

People remain in the program through age 74.

Depending on your previous screening history, you may have an exit test between ages 70 and 74.

If the result is reassuring and you have an adequate screening history, routine cervical screening can usually stop after this.

People who have had previous significant cervical abnormalities may need a different follow-up plan.

Your GP can check your screening history and advise whether you are genuinely finished with routine screening.

What if I have had a hysterectomy?

It depends on what was removed and why.

If your cervix remains, you generally still require cervical screening.

If your cervix was removed during a total hysterectomy, whether you need further testing depends on factors such as:

• why the hysterectomy was performed
• previous cervical screening results
• whether you have previously had significant cervical abnormalities or cancer.

Do not assume that having had a hysterectomy automatically means screening is finished.

Ask your GP to check your operative and screening history.

What if I have never had sex?

The routine screening program is aimed at people who have ever been sexually active because HPV is mainly transmitted through intimate sexual contact.

If you have never had any sexual contact, your risk is very low.

If you are unsure whether screening applies to your circumstances, discuss it with your GP rather than feeling obliged to undergo an unnecessary examination.

Do women who have sex only with women need screening?

Yes, if they meet the usual eligibility criteria.

HPV can be transmitted through intimate skin-to-skin sexual contact and does not require penile-vaginal intercourse.

Sexual orientation does not remove cervical-cancer risk.

If you have a cervix, are aged 25–74 and have ever been sexually active, routine screening remains relevant.

Does cervical screening test for other infections?

No.

The Cervical Screening Test is designed to detect high-risk HPV related to cervical cancer.

It is not a general sexual-health test.

It does not automatically test for infections such as:

• chlamydia
• gonorrhoea
• HIV
• syphilis.

If you need STI screening, tell your GP or sexual-health clinician so the appropriate tests can be arranged separately.

Questions people commonly ask

Is self-collection less accurate?

No, not for detecting HPV in routine screening.

Properly collected self-collected vaginal samples are just as effective as clinician-collected cervical samples for HPV detection.

The difference is that a self-collected sample does not provide cervical cells for every type of follow-up testing. If further cell assessment is needed, you may subsequently require a clinician-collected sample.

Will the self-swab hurt?

Usually very little, if at all.

It involves inserting a small swab into the vagina rather than using a speculum to visualise the cervix.

If you are uncomfortable or uncertain, stop and ask your clinician for help.

Can I do it completely at home?

The self-collection option still operates through a healthcare provider who orders and oversees the test.

How and where the sample is collected can depend on the service providing your screening.

Ask your GP or clinic what self-collection options they offer.

I had a normal Pap smear years ago. Am I still due?

Possibly.

The old two-yearly Pap smear system has been replaced by five-yearly HPV screening.

Your current due date depends on your previous screening history and results.

Your GP or the National Cancer Screening Register can help determine when you are next due.

Before your appointment

If possible, know:

• when you last had cervical screening
• whether it was a Pap smear or HPV Cervical Screening Test
• whether you have ever had an abnormal result
• whether you have had colposcopy or treatment to your cervix
• whether you have had a hysterectomy
• whether you are having symptoms such as bleeding after sex or bleeding after menopause.

You do not need to decide beforehand whether you want self-collection or clinician collection.

Ask about both options and choose what feels appropriate for you.

When should I see my GP rather than just wait for screening?

Book an appointment if you develop:

• bleeding after sex
• bleeding between periods that is unusual for you
• new bleeding after menopause
• persistent unusual vaginal discharge
• persistent unexplained pelvic pain or other concerning symptoms.

These symptoms are often caused by conditions other than cervical cancer.

But screening is not designed to investigate symptoms.

Do not wait until your next routine Cervical Screening Test if something has changed.

Start with one action

Find out when your next Cervical Screening Test is due.

If you are overdue because you have been avoiding a speculum examination, ask your GP or nurse about self-collection.

For many people, that one change removes the main barrier that has kept them from screening.

The bottom line

Cervical screening has changed significantly.

The current test looks for HPV, not simply abnormal cells, and for most eligible people it is needed only once every five years.

If you are aged 25–74, have a cervix and have ever been sexually active, routine screening remains important even if you have had the HPV vaccine.

And you now have a choice.

For most routine screening, you can either have a clinician collect the sample or collect your own vaginal swab.

A positive HPV result does not mean you have cancer. It means you need the appropriate follow-up.

And if you develop symptoms such as bleeding after sex or after menopause, see your GP rather than waiting for your next screening test.