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Aims: To examine outcomes in women aged 50–74 years after detection of oncogenic human papillomavirus (HPV) at cervical screening. Materials and methods: A retrospective observational study of 464 women seen in the Royal Women's Hospital Colposcopy Clinic from 1 January 2018 to 31 July 2020, 292 (62.9%) were positive for HPV16/18 and 172 (37.1%) for HPV (not 16/18). Results: Fifty‐four women (11.6%) had histologically proven CIN2+ including seven cancers, up to two years after first colposcopy visit (FCV): 48 (88.9%) detected at FCV or at excisional treatment (Excision) arranged after no CIN2+ detected at FCV. There was no significant difference (P = 0.14) in proportion of CIN2+ detected between the two groups, 'HPV16/18' (9.9%) or 'HPV (not 16/18)' (14.5%), nor with reflex cytology types. The positive predictive value (PPV) of high‐grade impression at colposcopy was 63.6%. There were 243 (52.4%) who had Type 3 transformation zone (TZ3) with 20 CIN2+ detected, 13 at FCV including all three cancers and five at Excision. There were 214 (73.3%) with positive HPV16/18 who had reflex negative cytology, of which seven had CIN2+ including one cancer but only two (1.4%) CIN2+ when their repeat cytology at colposcopy was negative. Conclusions: Most CIN2+ were detected at first colposcopy or at subsequent excision. We would encourage high biopsy rates at colposcopy and vigilance in selection for excisional treatment in TZ3 cases if there is no significant suspicion of high‐grade abnormality. There is a need to refine the algorithm for management of persistent HPV16/18 infections with reflex negative cytology to reduce colposcopy referrals in women aged 50 and above. [ABSTRACT FROM AUTHOR]

Background: Primary human papillomavirus (HPV) screening was introduced in Australia in December 2017. Aims: Outcomes for women after positive HPV in their cervical screening test (CST). Materials and Methods: A retrospective observational study of 4458 women seen at the Royal Women's Hospital Colposcopy Clinic from 1 January 2018 to 31 July 2020. Results: HPV16/18 was positive (considered higher‐risk CST) in 42.2% of women in the study, 16.6% with reflex possible with high‐grade squamous intraepithelial lesions (pHSIL) or worse and 54.9% with normal cytology. There were 24.8% of women with positive HPV16/18 who had histological confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 10.3% CIN2+ (including six cancers) among women with reflex negative cytology and 87.7% CIN2+ among women with reflex HSIL cytology. In women with positive HPV (not 16/18), CIN2+ was found in 60.2% with reflex pHSIL or worse cytology (higher risk) and 10.2% with reflex low‐grade SIL (LSIL) or normal cytology (intermediate risk). Median waiting time to colposcopy with the intermediate‐risk group went up to 181 days. Our colposcopists were able to achieve a positive predictive value (PPV) for CIN2+ of 69.9%, higher than 57.8% PPV in the National Cervical Screening Program (NCSP) 2020 monitoring report. Women with type 3 transformation zone on colposcopy could be followed up with CST if no HSIL was suspected on screening or at colposcopy as their risk of CIN2+ was only 2.5%. Conclusions: Our findings support direct referral to colposcopy for women with higher‐risk CST, with all cancers confined to this group. The NCSP recommendation to refer for colposcopy only after three intermediate‐risk CST will need monitoring with the LSIL triage group. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric disorders commonly occur during pregnancy and in the postpartum period, posing substantial risks to both mother and unborn child. Consequently, screening for maternal psychiatric disorder during pregnancy and in the postnatal period has been advocated. In this paper, we describe the development and evaluation of a screening tool for use with a ‘high risk’ demographic group – adolescent women seeking maternity care. Conclusions: The tool was developed to identify women with, or at risk of, psychiatric disorders requiring specialist assessment and/or treatment, rather than only those with psychosocial concerns and/or distress, or with depressive symptoms alone. The tool was administered by midwives and used during discussion at the maternity team multidisciplinary meeting to facilitate referral or seek advice through secondary consultation. The tool was well accepted by the women attending the clinic. All women in the group who received psychiatric care later – either during confinement or during the 6-week postnatal period of follow-up – had already been identified by the tool in the antenatal period. Arguably, the tool enabled early intervention, treatment planning and effective care. We suggest that rather than adopting a ‘one size fits all’ approach, any screening should be tailored to the population of interest. [ABSTRACT FROM AUTHOR]