When should I consider referring a patient for further investigation of HPV-related lesions?

Consider referring a patient for further investigation of human papillomavirus (HPV)-related lesions in the following situations:

• If cervical screening shows inadequate cytology results twice consecutively or if the high-risk HPV (hrHPV) test result is unavailable or inadequate, refer the patient to colposcopy for detailed assessment ¹.
• If colposcopy reveals abnormal changes suggestive of cervical intraepithelial neoplasia (CIN) or cancer, or if cytology shows borderline changes, low-grade or high-grade dyskaryosis, or glandular neoplasia, refer for further specialist evaluation ¹.
• For persistent or unexplained penile lesions or masses after exclusion or treatment of sexually transmitted infections, arrange urgent referral via a two-week suspected cancer pathway to exclude penile intraepithelial neoplasia or malignancy ³.
• Women with vulval lumps or ulcers that are unexplained should be referred urgently via a suspected cancer pathway ².
• Adults with anogenital lesions caused by molluscum contagiosum should be referred to genito-urinary medicine for STI screening, and referral to specialists is indicated if lesions are extensive, painful, or if the patient is immunocompromised ⁴.

Encourage participation in the NHS cervical screening programme for women aged 25–64 years and HPV vaccination for girls aged 12–13 years to prevent HPV-related lesions and cancers ⁵.