Getting an abnormal CST result is scary. The first thing to know is this: most abnormal results do not mean cancer. The screening system is designed to pick up early changes long before they could ever become anything serious. This guide walks you through exactly what each result means and what happens next. If you want background on how the test itself works, see our cervical screening test page.
What does the Cervical Screening Test actually look for?
The Cervical Screening Test, or CST, replaced the old Pap smear in Australia in 2017. It looks first for Human Papillomavirus (HPV), the virus that causes the majority of cervical cancer. If HPV is detected, the sample is then checked for cell changes under a microscope. The old blog on pap smears still has useful context.
The CST is done every 5 years for most women, from age 25 up to 74, as long as results stay normal.
The main CST result categories
HPV not detected
This is the result most women get. No HPV found, no action needed, and you come back in 5 years for your next test.
HPV detected (not type 16 or 18) with normal or low-grade cells
This is a common result. HPV is present but the cell changes are either not visible or only slightly abnormal (low-grade). You are usually asked to come back in 12 months for a repeat test. Most of these clear on their own without treatment.
HPV detected type 16 or 18
Types 16 and 18 are the two highest risk HPV types. If either is detected, you are referred for a colposcopy to have a closer look, regardless of the cell result. This is not an emergency, but it is not a wait-and-see result either.
High-grade cell changes
If the cells show high-grade changes (sometimes called HSIL), you will be referred for a colposcopy. High-grade does not mean cancer. It means changes that could, over many years, progress to cancer if not treated. The whole point of screening is to catch these early and treat them before any such progression.
What happens at a colposcopy?
A colposcopy is a close-up examination of the cervix using a special microscope called a colposcope. It takes about 10 to 15 minutes. Here is what to expect.
1. You lie on an examination couch, similar to a cervical screening test.
2. A speculum is placed in the vagina to see the cervix.
3. A dilute vinegar-like solution is applied to the cervix. This makes abnormal areas turn temporarily white, so they can be identified.
4. Your specialist examines the cervix through the colposcope, which sits outside your body.
5. If any abnormal areas are seen, a small biopsy (a tiny piece of tissue) may be taken for the laboratory. Most women describe this as a short pinch with no significant discomfort.
6. You can go home straight after. Light bleeding for a day or two is normal if a biopsy was taken.
What happens after the colposcopy?
The biopsy results usually come back within 1 to 2 weeks. Based on what the laboratory finds, there are three main pathways:
1. No treatment needed: just a repeat CST or colposcopy in 12 months.
2. Treatment to remove the abnormal area: usually a procedure called LLETZ.
3. In rare cases where cancer is found or suspected, referral to a gynaecology oncology team for further management.
What is LLETZ?
LLETZ stands for Large Loop Excision of the Transformation Zone. It is a short procedure that removes the abnormal area of the cervix. A thin wire loop with electrical current is used to cut out the affected tissue, which is then sent to the laboratory for full examination.
LLETZ is usually done under light anaesthetic as a day procedure. It takes about 15 minutes. Most women experience mild cramping and some vaginal discharge for 2 to 4 weeks afterwards. You can return to normal activity the next day, with some simple precautions:
1. No tampons for 4 weeks.
2. No sex for 4 weeks.
3. No swimming pools or spas for 4 weeks.
4. Pads only during this time.
Does LLETZ affect fertility or pregnancy?
For most women, LLETZ has no significant impact on future fertility. There is a small increase in the risk of preterm birth in later pregnancies if a lot of tissue is removed. Your specialist will consider this when planning your treatment, especially if you have not yet had children or plan to have more.
Follow-up after treatment
After LLETZ, you will have a follow-up CST (called a test of cure) at 6 and 18 months. If both are clear, you return to the normal 5-year screening pattern.
Can I prevent abnormal results in future?
Yes, to some extent. The strongest step is the HPV vaccine, which protects against the main cancer-causing HPV types. It is free in Australia for school-aged children and is also available for adults up to age 45. Not smoking and keeping up with regular screening are also important.
About Northside Gynaecology and colposcopy care
Northside Gynaecology is a specialist gynaecology practice in Brisbane. Our team, led by Dr Archna Saraswat, FRANZCOG, performs colposcopy and LLETZ regularly. We prioritise colposcopy referrals so you are seen promptly after an abnormal CST result. We consult from Kedron, North Lakes, and Caboolture Private Hospital.
Frequently asked questions
Does HPV positive mean I have cancer?
No. HPV is a very common virus and most HPV infections clear on their own without causing any problem. HPV positive on your cervical screening test simply means the virus has been detected. Further checks look to see if it has caused any changes in the cervical cells that need treatment.
What is a colposcopy?
A colposcopy is a close-up look at the cervix using a special microscope called a colposcope. It takes about 10 to 15 minutes and feels similar to a cervical screening test. If any abnormal areas are seen, a small biopsy may be taken for the laboratory to check.
What does LLETZ mean?
LLETZ stands for Large Loop Excision of the Transformation Zone. It is a short procedure that removes the abnormal area of the cervix using a thin wire loop with electrical current. It is usually done under light anaesthetic and takes about 15 minutes.
How urgently do I need a colposcopy?
The urgency depends on your result. Low-grade changes with HPV may be managed with a repeat test in 12 months. High-grade changes usually need a colposcopy within a few weeks. Your specialist or GP will advise based on your specific result.
Will I need a hysterectomy?
Almost never for abnormal CST results alone. Hysterectomy is only considered in rare cases where multiple treatments have not cleared the problem, or if cancer is diagnosed. The vast majority of women never need surgery beyond LLETZ, if that.
Can I still get the HPV vaccine as an adult?
Yes. The HPV vaccine is approved in Australia for adults up to age 45. It is not free for adults, but it is available. Talk to your GP about whether it would be helpful for you.
How soon can I have sex after a biopsy or LLETZ?
After a simple biopsy, usually a few days once bleeding has settled. After LLETZ, no sex for 6 weeks. Your specialist will give you clear personal advice.
Book a colposcopy appointment in Brisbane
An abnormal CST result is worrying, but it is also an opportunity. The system is working exactly as it should, finding changes early so they can be dealt with simply.
You can book a colposcopy appointment at Kedron, North Lakes, or Caboolture Private Hospital. Call 07 3054 4687 or use our contact page. Please mention this is for an abnormal CST so we can prioritise your appointment. Bring your result letter and any GP referral you have.