When should I consider referring a patient for further investigation o

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 or if high-risk HPV (hrHPV) test results are unavailable or inadequate on two occasions, refer for colposcopy for detailed assessment .
If colposcopy reveals abnormal changes suggestive of cervical intraepithelial neoplasia (CIN) or cancer, or if cytology shows high-grade dyskaryosis or glandular neoplasia, urgent referral for further investigation is warranted .
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 .
Women with vulval lumps or ulcers that are unexplained should be referred urgently via a suspected cancer pathway .
Adults with anogenital lesions caused by molluscum contagiosum should be referred to genito-urinary medicine for STI screening, and referral to specialists is advised if lesions are extensive, painful, or in immunocompromised patients .

Encourage participation in cervical screening and HPV vaccination to prevent HPV-related lesions and cancers .

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