Co-Infections: Herpes, Chlamydia, and HPV in Women

Regarding the co-infection of herpes simplex virus types 1 and 2, Chlamydia, and HPV?

Hello Doctor,
In September 2019, during a pre-marital health check, I was tested for sexually transmitted infections (STIs) including HIV, syphilis, chlamydia, herpes types 1 & 2, candidiasis, trichomoniasis, and HPV.
The only positive result was for candidiasis.
However, in February 2020, I sought medical attention for urethritis, and the doctor suggested further testing if I was planning to conceive.
I underwent additional tests, including STI screenings, and this time the results showed HPV infections for types 61 and 84; chlamydia was reported as Chlamydia IgG (+) 31.1; HSV 1 IgG for herpes type 1 (+) 2.89; and HSV 2 IgG for herpes type 2 (+) 3.11.
The report indicates that HPV, chlamydia, and herpes types 1 & 2 were all positive, while the tests from September of last year were negative.
My only sexual partner has been my husband, which has left me quite shocked.

I researched various articles online and found that there are different testing methods for chlamydia and herpes.
I reviewed my reports: the chlamydia test in September 2019 was a chlamydia DNA test (which is a urine and secretion test, correct?), while the February 2020 test was a chlamydia IgG test (a blood test).
The herpes tests in September 2019 were HSV 1 DNA and HSV 2 DNA tests (which also seem to be secretion tests?), while the February 2020 tests were HSV 1 IgG and HSV 2 IgG (blood tests).

I would like to ask the doctor:
1.
Is it possible that the different testing methods caused the negative results for herpes types 1 & 2 and chlamydia in September 2019 to show positive in February 2020?
2.
Does a DNA test of secretions indicate whether there is an active infection of these viruses or bacteria at that moment? Does an IgG test indicate a past infection that will show positive in the blood?
3.
How can I determine if these infections occurred between September 2019 and February 2020 (indicating a new infection) or if I was already infected before September 2019? I read that a sudden spike in HSV 2 IgG levels above four times the normal range indicates a recurrence of herpes type 2; what does "four times the normal range" approximately translate to in numerical values?
4.
Can the level of chlamydia infection indicate whether it is a recent infection or a long-standing antibody response? My result was Chlamydia IgG (+) 31.1, with the following interpretation: (-) <16; (+/-) 16-22; (+) >= 22.
Does this indicate a current infection, a past infection, or a reactivation of the virus? However, I have never experienced pelvic inflammatory disease or outbreaks of herpes (on my face, lips, or body), which may suggest that I have not been infected with chlamydia or herpes previously.
Are these infections recent?
5.
How long do IgG antibodies for chlamydia and herpes last after infection, or when might they become undetectable and show negative results? Do they remain positive for life? Do these viruses persist in the body? Does low immunity lead to herpes outbreaks, or is it possible to remain asymptomatic for life? What treatments are currently available? (My husband also seems to show no symptoms; otherwise, I would have noticed.)
6.
I received the 9-valent HPV vaccine, but I found that types 61 and 84 are not included in the vaccine.
Could it be possible that I was infected with types 61 and 84 before September 2019 but was not tested for them? Or could this have occurred afterward? Is it possible for HPV tests to yield negative results due to low viral load? The report states that these two types are low-risk; I could not find any related conditions associated with them online.
Are there any cases or literature indicating that types 61 and 84 could cause any diseases? Can the virus disappear over time?
7.
Could chlamydia, herpes types 1 & 2, and HPV types 61 and 84 potentially lead to any type of gynecological cancer?
Thank you for taking the time to read my concerns, and I look forward to your response! I am truly distressed and hope to receive your reply.
Thank you once again!

Fanrao de ren, 20~29 year old female. Ask Date: 2020/03/06

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the tests you mentioned have considerable variability and are not considered gold standards for disease diagnosis.
IgG typically indicates a previous infection, and you may consider an IgM test for further reference.
For HPV, you can consult a gynecologist to check for infections in the reproductive tract.
It is advisable to discuss the interpretation of previous test results with the physician who conducted the tests for clarity.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2020/03/06

More Info

Understanding co-infections such as Herpes, Chlamydia, and HPV in women is crucial for maintaining reproductive health and preventing complications. Your situation raises several important questions regarding the nature of these infections, their transmission, and their implications for your health and that of your partner.

1. Differences in Testing Methods: It is indeed possible that the differences in testing methods contributed to the variations in your results. The DNA tests for Chlamydia and Herpes (HSV) detect the presence of the bacteria or virus at the time of testing, indicating an active infection. In contrast, IgG tests measure antibodies in the blood, which indicate past exposure to the infection. Therefore, a positive IgG result for Chlamydia suggests that you have been infected at some point, but it does not confirm an active infection. The initial negative results could have been due to the absence of the infection at that time or limitations in the sensitivity of the tests used.

2. Understanding IgG and DNA Tests: DNA tests for Chlamydia and Herpes provide immediate results regarding active infections, while IgG tests indicate past infections. If you have a positive IgG for Chlamydia, it suggests a previous infection, but it does not confirm if you are currently infected. The presence of antibodies can remain in the body for years, indicating past exposure rather than current infection.

3. Determining Infection Timing: To ascertain whether your infections occurred between the two testing periods or prior, you would need to consider the timing of symptoms and any potential exposures. Unfortunately, without specific symptoms or additional testing, it can be challenging to determine the exact timing of the infections.

4. Interpreting Chlamydia IgG Levels: The Chlamydia IgG level you provided (31.1) indicates a past infection, as it exceeds the threshold for positivity. However, it does not specify whether the infection was recent or long-standing. The absence of symptoms like pelvic inflammatory disease or herpes outbreaks may suggest that you were not actively infected at the time of testing.

5. Persistence of Antibodies: IgG antibodies for both Chlamydia and Herpes typically remain in the body for a long time, often for life. This means that even if you are no longer infected, the antibodies can still be detected. The presence of these antibodies does not necessarily indicate an active infection, and many individuals can remain asymptomatic.

6. HPV and Vaccination: Regarding HPV types 61 and 84, it is possible that you were infected before your vaccination, as the vaccine does not cover all HPV types. HPV testing can sometimes yield false negatives, especially if the viral load is low. Types 61 and 84 are considered low-risk and are not typically associated with cancer, but they can cause benign conditions like genital warts.

7. Cancer Risks: While HPV is a known risk factor for several cancers, particularly cervical cancer, types 61 and 84 are not associated with significant cancer risk. Chlamydia can lead to complications such as pelvic inflammatory disease, which can affect fertility, but it is not directly linked to cancer. Herpes, particularly HSV-2, can cause recurrent outbreaks but is not a direct cause of cancer either.

In summary, it is essential to maintain regular check-ups and screenings, especially if you have a history of infections. Open communication with your partner about sexual health is also crucial. If you have concerns about your infections or their implications, consider consulting a healthcare provider who can offer personalized advice and treatment options. Regular monitoring and preventive measures, including vaccination and safe sex practices, can help manage your health effectively.

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