What are the diagnostic tests for herpes, human papillomavirus (HPV), and trichomoniasis in a patient with cervicitis?

From the Guidelines

For a patient with cervicitis, the most appropriate diagnostic tests for herpes, human papillomavirus (HPV), and trichomoniasis are PCR testing of lesion material for HSV, cervical cytology (Pap smear) combined with HPV DNA testing for HPV, and nucleic acid amplification tests (NAATs) for trichomoniasis, as these methods offer higher sensitivity and specificity compared to other diagnostic approaches. When diagnosing herpes simplex virus (HSV), it is essential to collect samples from visible lesions using a viral culture swab or perform PCR testing of lesion material, which is more sensitive than viral culture, as noted in the 2022 study 1. Blood tests for HSV antibodies can also help determine previous exposure but do not confirm active infection. For human papillomavirus (HPV), testing typically involves cervical cytology (Pap smear) combined with HPV DNA testing from cervical samples. For trichomoniasis, collecting vaginal secretions for microscopic examination (wet mount) to identify motile trichomonads or using NAATs, which offer higher sensitivity, are recommended, as outlined in the 2018 guide to utilization of the microbiology laboratory for diagnosis of infectious diseases 1. Point-of-care rapid antigen tests are also available for trichomoniasis. It is crucial to note that cervicitis may have multiple causes, so comprehensive testing should include screening for chlamydia and gonorrhea as well, as suggested in the 2006 sexually transmitted diseases treatment guidelines 1 and the 1993 sexually transmitted diseases treatment guidelines 1. Proper specimen collection is vital for accurate results, and patients should be counseled about the implications of positive results and the importance of partner notification and treatment when appropriate. Key considerations in the diagnostic approach include the sensitivity and specificity of the tests, the presence of symptoms, and the potential for false-negative or false-positive results, as discussed in the context of HSV diagnosis 1. By prioritizing the most sensitive and specific diagnostic methods and considering the complexities of cervicitis, healthcare providers can ensure the best possible outcomes for patients in terms of morbidity, mortality, and quality of life. Some of the key points to consider when diagnosing and managing these infections include:

• The use of NAATs for the diagnosis of trichomoniasis, which offers higher sensitivity compared to wet mount examination or culture, as noted in the 2018 guide 1.
• The importance of comprehensive testing, including screening for chlamydia and gonorrhea, to address the potential multiple causes of cervicitis, as suggested in the 2006 guidelines 1 and the 1993 guidelines 1.
• The need for proper specimen collection and handling to ensure accurate diagnostic results, as emphasized in the 2018 guide 1.
• The role of patient counseling and education in the management of these infections, including discussion of the implications of positive results and the importance of partner notification and treatment, as part of a comprehensive approach to care.

From the Research

Diagnostic Tests for Herpes, HPV, and Trichomoniasis in Cervicitis

• The diagnosis of cervicitis involves commercial systems based on molecular techniques that include almost all known pathogens associated with cervicitis 2.
• Cultures should not be abandoned due to the need to conduct studies of susceptibility to antibiotics 2.
• For women with low risk of sexually transmitted infection, antibiotic therapy should be adjusted to the results of the microbiological results 2.
• Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis 3.

Specific Diagnostic Tests

• Human papillomavirus (HPV) testing can be used in the management of women with abnormal Pap smears 4.
• HPV testing and viral typing for both low-risk and high-risk types can be performed using nested PCR-based techniques 4.
• Colposcopy and punch biopsy can also be used to diagnose cervical lesions and condylomatosis, which are characteristic of Papillomavirus infections 4, 5.
• Antiviral treatment with Acyclovir or Valacyclovir can be effective in treating genital Herpesvirus infections and may also be effective in treating HPV-related lesions 5.

Associated Factors and Recommendations

• Sexually active women younger than 25 years old, new or multiple sexual partners, partners with STI, previous history or presence of other STI, and irregular use of condoms are associated factors to cervicitis 3.
• Screening, diagnosis, and treatment of affected people and their sexual partnerships are crucial for controlling the spread of pathogens that cause cervicitis 3.
• Strategies for surveillance, prevention, and control of these infections should be implemented by health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections 3.