Doing an HPV swab (self-test) The vaginal swab is an easy way for most people to collect their screening sample. It is quick and should not be uncomfortable. If you prefer, your healthcare provider can help you with your swab test. If you choose to do a self-test you will be given a kit with the following detailed instructions. Step 1 - Wash your hands with soap and water and dry them thoroughly. Step 2 - In a private space, find a comfortable position to take your sample. You may like to sit, stand, lie down or squat. If you cannot find a position that works for you, ask your healthcare provider for help. Step 3 - Take the tube containing the swab out of the bag and remove the swab stick. You may need to hold and twist the cap to break the paper seal. Try not to touch the swab tip either with your fingers or against any surface. Step 4 - Holding the swab stick about halfway down, use your free hand to open your vagina and gently insert the tip of the swab about 4-5cm (about the length of you thumb, similar to inserting a tampon). Step 5 - Rotate the swab 4 times for about 20 seconds, gently touching the sides of the vagina, then remove. Put the swab back into the tube. Step 6 - Dispose of any leftover materials in the rubbish bin, then wash your hands with soap and water and dry them thoroughly. Step 7 - Place the completed sample and form back into the bag, seal it and give it back to your healthcare provider who will send it for testing. If you make a mistake It is very unlikely you will get anything wrong. It is ok to continue with the test if you: have touched the swab tip with your fingers (though it is best to avoid this) have inserted the swab into your vagina but are unsure if you have inserted it far enough If you drop your swab let your healthcare provider know and ask them for a replacement. Cervical Sample A cervical sample can only be taken by a trained health professional. The sample is taken from your cervix. The test is usually done in a clinic or health centre, but some healthcare providers may offer other locations, such as community settings or mobile units. Cervical Sample tests only take about 10 minutes. It is best to avoid having your test during your period (menstruation). Here’s how it usually works. Discuss what is going to happen with the person taking your smear, and make sure they have explained it clearly. You can lie on your side or your back (whichever is more comfortable) with your knees bent up. Let the smear taker know your preference. It’s up to you how modest you want to be – cover up with the sheet provided if it feels better. They will open your vagina gently with a plastic or metal speculum. They use a small, soft brush to take a small sample of cells from the surface of your cervix. Once that's done, you can get dressed. They’ll confirm how you will receive your results. Your test sample is sent to a laboratory, and checked for any cell changes. Your results will be sent to your smear taker after a couple of weeks. Further tests or treatment will be arranged if your results require it. You may find it a little bit uncomfortable, but if you feel pain or discomfort at any time let the person taking your smear know straight away. If this is a follow-up test after HPV has already been found in a vaginal swab test, your cervical sample will be used to check for cell changes. If you have not had an HPV swab test, the cervical sample will first be tested for HPV. Only if the virus is found will the sample then also be checked for cell changes. For more information visit www.timetoscreen.nz or call us on 0800 729 729

Understanding HPV test results Screening tests first show whether you have HPV. These results are usually available within 1-2 weeks. Around 90% of people screened will NOT have HPV found and can just continue to have regular screening. This will usually be 5-yearly (or 3-yearly if immune deficient). About 10% of people screened will have HPV found. This does NOT mean you have cancer. It may mean there is a risk of already having or developing precancerous cell changes on your cervix, so further checks are important. The next steps will depend on what type of HPV is found. These follow up tests check for any cell changes on your cervix. Let’s look at what the results mean. HPV not detected If HPV isn't found in your sample, you won't need to have another screening test for 5 years (or 3 years if you are immune deficient). HPV 16 or HPV 18 There are many different types of HPV. Some strains are more likely to persist and may lead to cervical cancer. If HPV types 16 or 18 are found (the 2 highest-risk types) you'll be referred for colposcopy to check for cell changes. This examination is done by a specialist colposcopist who uses a microscope to magnify and sometimes takes samples from your cervix. Most people who have HPV 16 or 18 will not have any cell changes, but it is important to check. HPV Other (type/number may be stated) If one of the 'Other' types of HPV is found, and your test was done as a vaginal swab, you will be asked to go back to your healthcare provider to have a cervical sample taken (previously known as a smear test). This will be sent to the laboratory and tested for any cell changes (cytology). If you choose to have a cervical sample taken (rather than a swab test) you won't need to come back for this second appointment. The sample will be used to check for cell changes. Depending on what type of cell changes are found you may then be referred for colposcopy. Invalid or unsuitable for analysis Very occasionally an HPV swab sample won't be able to be used for testing. You will be told if your test is unusable, so you can repeat it. Understanding Cytology test results Cytology screening (looking at cells under a microscope) looks for changes in the cells on the surface of the cervix. if you have a cervical cell sample taken and a cytology result is reported as well as HPV, the results are more complex. The cytology results that may be reported are: Normal cytology results (a negative result) No cell changes were detected. Future follow-up will depend on your screening history. Unsatisfactory results mean that the test could not be read at the laboratory because there were not enough cells in the sample, or blood or mucus hid most of the cells. You will need to have another test within three months. Inflammation or infection Occasionally your test result may show that inflammation or infection is present. Discuss this result with your healthcare provider. Often no treatment is required. Atypical changes This means it is difficult to be sure whether cell changes are starting to develop. mild atypical changes (called ASC-US or atypical squamous cell of undetermined significance) often clear up before your next test. Mild (low-grade) changes (LSIL) This means the cells are beginning to show some mild changes. LSIL (or low-grade squamous intraepithelial lesions) are due to an HPV infection. These usually clear up on their own, so your next screening test may be normal. If it's not, you may be referred for colposcopy. This will depend on your age and how many times HPV has been detected in your screens. Your healthcare provider will discuss this with you and confirm if you need to have another screening test in 1 year, or be referred to a specialist. Moderate to severe (high-grade change (HSIL) High grade changes are cell changes that are more developed. They're called high-grade squamous intraepithelial lesions (HSIL). This doesn't mean cancer (most people will have cell changes that can be successfully treated), but you'll need colposcopy to check. Most cell changes are either LSIL or HSIL. Occasionally there are glandular cell changes, which are also regarded as a high-grade change requiring further investigation. You may be recommended for further tests or treatment following your cervical screening results. Your healthcare provider will explain why you need any follow-up procedures and what they will involve. Cancer If you smear test shows any changes suggestive of cervical cancer, you will be referred to a specialist within 1 week. The sooner this is treated, the better the chances of success. It's important for you to go to your appointment.

If your cervical screen shows an abnormal result, you may need an extra check called a colposcopy. You’ll be sent an appointment time for a colposcopy at the public hospital. This is free. It’s important to go to your appointment even if you don’t have any symptoms. What is a colposcopy? A colposcopy is when a specialist examines your cervix using a special microscope called a colposcope. After they’ve done the colposcopy, the specialist will discuss their findings with you. Sometimes, if they see something that concerns them, they will take a biopsy. This means taking a tiny sample of tissue from your cervix and having it checked it at a laboratory, just to be sure. Colposcopies are a safe and effective check.