From the Guidelines
To order tests for HSV, syphilis, and HPV, you should schedule an appointment with your healthcare provider and specifically request testing for these three sexually transmitted infections. For HSV, the most recent and highest quality study 1 recommends using nucleic acid amplification tests (NAATs) or polymerase chain reaction (PCR) diagnostic assays, which have >90% sensitivity and specificity, to detect HSV-1 or HSV-2 from a genital ulcer or lesion. For syphilis, the study 1 suggests using a reverse syphilis screening algorithm, which involves a treponemal specific test first, such as an enzyme immunoassay (EIA) or chemiluminescent immunoassay, followed by a nontreponemal test, such as a rapid plasma reagin (RPR), to confirm the diagnosis. For HPV, testing options differ by gender, with women able to get HPV testing along with a Pap smear, while men are typically diagnosed only if they develop visible genital warts or through anal Pap smears in certain high-risk populations. Some key points to consider when ordering these tests include:
- Many clinics offer comprehensive STI panels, but you may need to specifically request HSV testing as it's not always included in standard panels.
- Insurance often covers these tests, especially if you have symptoms or known exposure, but check with your provider about coverage.
- Testing is important because these infections can be asymptomatic but still transmissible and may lead to serious health complications if left untreated.
- It's essential to follow the recommended testing algorithms and use the most sensitive and specific tests available to ensure accurate diagnosis and treatment. The most recent study 1 also highlights the importance of testing for other sexually transmitted infections, such as chlamydia and gonorrhea, in addition to HSV, syphilis, and HPV, especially in high-risk individuals.
From the Research
Ordering Tests for HSV, Syphilis, and HPV
To order tests for HSV, syphilis, and HPV, the following steps can be taken:
- Obtain a sexual history to assess for behaviors that increase a patient's risk 2
- Consider community and population risk factors 2
- Perform a clinical examination, including inspection of the genital and anal region, throat, and skin 3
- Offer risk-adapted STI tests, including tests for syphilis, HIV, and hepatitis B virus infection 3, 2
Testing Recommendations
- The USPSTF recommends screening for syphilis in persons at increased risk 2
- The USPSTF recommends against screening for asymptomatic herpes simplex virus infection 2
- There is no recommendation for routine screening for HPV, but it may be considered in certain high-risk populations 2
Diagnostic Workup
- Medical history taking should include sexual orientation and practices, symptoms of sex partners and symptom-free intervals, previous STI and other medical conditions, previous treatment, vaccination status, contraceptive methods, and condom use 3
- Clinical examination should depend on anatomy, sexual practices, and symptoms 3
- The goal is to diagnose oral and anal STI and provide guideline-based treatment, including monitoring of outcome 3