Q: I'm confused by the news that new HPV tests are available. How are these tests different and I don't understand how a test that detects certain types of the virus is helpful. Isn't my Pap good enough?

A: Good for you that you are keeping up with the current news in cervical cancer prevention! You are correct that a new HPV test is available, so I will try to explain its use.

There are now 2 FDA approved HPV tests: The Hybrid Capture 2 HPV DNA test and Cervista HPV test. The Hybrid Capture 2 test has been available for almost 10 years. It tests for a panel of 13 high risk viral strains and if the test returns “positive” it means that one or more of those strains have been detected. This test is recommended for two uses--- with women over age 20 when a Pap test returns in a borderline category, called atypical squamous cells of undetermined significance (ASC-US); and in women over the age of 30 when doing both a Pap test and an HPV test.

Cervista HPV was just recently FDA-approved in March 2009. It also has a high risk panel of the same 13 viral strains as the Hybrid Capture 2 test but it adds one more strain that has been found to cause cervical disease. It is also approved for the same two indications as above: for reflex testing for an ASC-US Pap result and for primary screening of women age 30 and older.

What Cervista also offers is the ability to tell if either type 16 or type 18 is present; this is called genotype specific testing. We know that these two strains cause the majority of cervical cancers. If the Cervista high risk panel is positive, then further testing can be done from the same sample to see if either type 16 or 18 is present. Women under the age of 30 are very likely to clear their HPV infection, so genotype specific testing is not particularly helpful in this age group. However, it may be especially important for women over 30 as cervical cancer rates begin to rise.

If types 16 or 18 are present, it does not mean that you have or will get cervical cancer. It simply means that your healthcare provider has another tool to help determine the appropriate follow up for you

--Beth Colvin Huff, MSN, FNP-BC
Vanderbilt University Medical Center

---

Q: About a year ago, my partner was diagnosed with high-risk HPV and had an abnormal Pap test. She went ahead and had a procedure done to remove abnormal cell changes from her cervix, and everything has come back normal on her follow-up visits.

For about a year and a couple months now, our lives changed completely. I live with this everyday, always conscious of it, and if I get sick or feel something funny I panic and think it is somehow related to the HPV. My doctor told me if I do have the virus, not to worry about it and continue to live my life the same.... I wish I could do that! I just want to stay on top of this. What type of tests or screening should we be doing now?

A: I appreciate your concern about your partner’s health and it sounds as if she has done the right thing by getting screened and then treated for the abnormal cells. The goal of Pap tests and in some cases, HPV testing, is to identify women at risk for developing cervical cancer. Now that she has been treated, she will need to keep up with recommended exams to make sure that her tests go back to normal.

I am concerned, however, about the emotional impact this has made in your daily lives. Although HPV has been associated with penile and anal cancers in men, these are far less common than the cellular abnormalities in women. High risk HPV causes no symptoms in men or women- no pain, discharge or bleeding. The HPV test is not approved for use in men as it is not as accurate as it is in women. The HPV vaccine is currently not approved for use in men.

We assume that men, just like most women, will clear the HPV through your immune response. In fact, you may have cleared it already, but again, we have no way of testing to know that for sure. In the meantime, the better support you can give your immune system, the better it will support you in helping to clear the virus. If you smoke, try to stop. Eat a good diet with antioxidant–rich fruits and vegetables and get adequate rest. Manage your stress in whatever way works best for you—exercise, hang out with people you care about, get involved in a cause. The benefits you get back from these healthy behaviors will pay you back in many ways!

Because HPV tends to be so common in younger age groups, it is often the first health concern that is faced and can create personal and relationship stress. If you feel that you are not getting the answers you need, talk to another provider or educate yourself through websites like this one.

--Beth Colvin Huff, MSN, FNP-BC
Vanderbilt University Medical Center

---

Q: Please help. Would you please tell me how long a person can have trichomoniasis and carry it? Could it have been passed on almost three months with only light symptoms?

A. This is such a common question that it is surprising how little we know about the answer. No one knows exactly how long someone can have vaginal trichomoniasis with few or no symptoms. We do know that women can have this infection for at least three months without symptoms of any kind, and we know that it can be transmitted to a sex partner even when it is causing no symptoms.

The diagnosis of trichomoniasis often raises questions for couples about their partner's faithfulness. Although trichomonas is always transmitted by sexual contact, the fact that trichomonas can survive for several months, maybe even longer, means that an infection could have been acquired in a previous sexual relationship that ended several months earlier.

It's also important to remember that men can have trichomonas but almost never have symptoms. And, we know next to nothing about how long some men may have trichomonas. It's also important to know that making a diagnosis of trichomonas infection in men can be very difficult.

Click here to learn more about trichomonas infection.

J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

---

Q: I have been living with both genital herpes and genital warts for many years. My husband passed away 6 years ago, and I only learned afterwards about shedding and that a person can have no symptoms and pass the virus on. I was originally told I could only pass the virus on when I had an active outbreak, and have never understood how someone can have herpes and not experience symptoms.

A: First of all, it’s important to separate genital herpes from genital warts. Both are caused by viruses. However, the viruses are different, and they cause different kinds of symptoms.

Genital herpes is caused by two related but different herpes viruses: Herpes simplex virus type 1 (HSV 1) and Herpes simplex virus type 2 (HSV 2). Infections with HSV 1 are very common (about 75% of adults, depending on age and where you live) and usually cause an infection with few symptoms: most people never know they have it. HSV 1 infections can be passed during sex from one person to another, but it can also be passed by other types of contact as well. If people do have symptoms of HSV 1 infection, it is often with recurrent sores around their lips and mouth, commonly known as “cold sores” or “fever blisters.”

HSV 1 often causes genital herpes outbreaks. When it does, it is often only once. Then, the person never has another outbreak even though they still have the herpes infection. Their sex partners don’t get this infection because HSV 1 infections are already so common. This may explain your story because we’ve only known how to do specific tests for HSV 1 and HSV 2 for the past few years.

HSV 2 is different. HSV 2 infections are less common than HSV 1. However, about 25% - 30% of adults in the United States have an HSV 2 infection. HSV 2 infections are what people are usually thinking about when they talk about genital herpes. It usually passed between people by sexual contact. However, most people with HSV 2 don’t know they have it either. Some people, however, get genital herpes outbreaks, often several times each year.

Genital warts are usually caused by human papilloma viruses (HPV). There are more than 100 types of these viruses, but only two of these types cause most cases of genital warts. Other HPV types cause several different types of genital and head/neck cancer. Although we are still learning more about HPV infections, most people with genital warts get over them without any complications. It’s important to know, however, that a vaccine is now recommended for almost all young women between ages 9 and 26 years that will prevent HPV infections by the two types that cause most genital warts, as well as the two types that cause most cancers.

J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

Read more about genital herpes, including how the virus can be active without symptoms, at ASHA's Herpes Resource Center. For more on HPV, visit our HPV Resource Center.