Experts tell Louisiana task force HPV, herpes testing limits complicate claims of intentional transmission; HIV prevention is effective when treated

Dr. Meredith Clement, an infectious‑disease physician and researcher in New Orleans, told the HR 3 22 task force that human papillomavirus (HPV), hepatitis B (HBV), herpes simplex virus (HSV) and HIV have different testing, transmission and public‑health profiles and that those differences affect how public health officials and prosecutors can establish transmission. "Human papillomavirus ... is the most common STI globally," Clement said, and she cautioned that routine testing and surveillance differ between infections.

Clement said HPV is typically diagnosed during cervical exams; there is no routine blood (antibody) test for HPV and no standard genital test for men, so "you cannot prove directionality" of transmission from HPV tests alone. For hepatitis B, she explained the difference between antigen/PCR testing and antibody testing and said the CDC recommends at least one screening test in a lifetime, adding that fewer than 5 percent of adults who are infected progress to chronic infection. On herpes, Clement said definitive diagnosis requires PCR of a lesion and that serology has limited utility because of false positives and negatives and because many infections are asymptomatic but still intermittently shed virus.

On HIV, Clement noted the large body of clinical evidence that effective antiretroviral treatment that suppresses viral load makes sexual transmission essentially impossible. "Undetectable equals untransmittable," she said, summarizing trials showing no documented sexual transmissions from virally suppressed people in large partner studies. She also summarized clinical prevention tools: post‑exposure prophylaxis begun within 72 hours and several highly effective pre‑exposure prophylaxis options, including long‑acting injectables.

The Louisiana Department of Health staff clarified what the state formally tracks: HIV and hepatitis B are reportable conditions, and the department maintains a surveillance repository for positive tests. "HPV and HSV are not reportable and we do not maintain local data on them," an LDH presenter said, explaining that the ubiquity of those infections and limits of available tests reduce the value of routine reporting for population surveillance. LDH staff also described the state's molecular HIV surveillance program, which can identify clusters of related recent diagnoses for public‑health action but cannot reliably prove who infected whom.

Task force members repeatedly raised the question of legal proof of directionality and intent. Clement and LDH staff told members that, except in narrow circumstances where serial negative tests are documented before a single exposure and subsequent acute illness is well documented, laboratory proof that one named person infected another is generally not available for HPV or HSV and is difficult for HBV and HIV.

The task force asked staff to return with surveillance trends and programmatic data at the next meeting, and members discussed using the clinical distinctions Clement outlined when crafting policy or legal recommendations.