What criteria should I use to determine whether to refer a patient wit

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

Criteria for referral of a patient with cervical intraepithelial neoplasia (CIN) for colposcopy include:

Referral is indicated for people who test positive for high-risk human papillomavirus (hrHPV) with abnormal cytology results, as these findings suggest the presence of CIN2+ lesions that require further assessment by colposcopy.
People who are hrHPV positive but have negative cytology should have repeat HPV testing at 12 and 24 months; persistent hrHPV positivity at 24 months warrants referral to colposcopy.
Individuals with inadequate cytology results or unavailable hrHPV test results on two consecutive occasions should be referred for colposcopy.
People with cytology showing high-grade dyskaryosis or severe abnormalities should be referred promptly for colposcopy.
Following treatment for CIN, a test of cure (repeat cervical sample) is performed 6 months after treatment; if hrHPV is positive but cytology is negative, referral to colposcopy is recommended.
Pregnant individuals with abnormal screening results may undergo colposcopy in the late first or early second trimester unless contraindicated; low-grade changes may be deferred until after delivery.

These criteria ensure timely identification and management of pre-cancerous cervical lesions to prevent progression to cervical cancer.

References:

What criteria should I use to determine whether to refer a patient with CIN for colposcopy?