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Dermatology (Expert Forum)
Specificity of HSV IgM and Timing of Titers
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
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Specificity of HSV IgM and Timing of Titers
by bbybtt, Apr 13, 2005 12:00AM
I developed a single initially painless vesicle on my lower abdomen several days after intimate contact. Not knowing if it was bacterial or a solitary herpetic lesion, I took acyclovir and azitrhomycin. I popped the vesicle myself and it became a tiny painful ulcer approx 4 mm in diameter that healed.
4 weeks after the incident I've had Herpeselect HSV HSV 1,2 IgG serology and HSV IgM W/RFX titer. HSV IgM was detected, titer 1:10 whcih is the reference range for positive. IgG were negative.
I have had VZV as a child and EBV as an adult but years ago. 5 months ago I had a weeklong febrile illness with night sweats that was qualitatively similar to EBV but I had no serology.
1)My question- Quest diagnostics states that there is cross-reactivity between HSV IgM and VZV,EBV,CMV, but would this cross reactivity occur years after VZV, EBV, etc.
2)Other question, what is the time frame over which 100% of patients have IgG seroconversion?
3)Last crazy question- since this is on my lower abdomen, the dermatome has a direct path around my torso---> since the reactivation is travel along the nerve from the dorsal root, could abdominal recurrences be prevented by disrupting the nerve path, such as with a paraspinal full thickness skin excision, so that future recurrences would occur on the back instead?
4 weeks after the incident I've had Herpeselect HSV HSV 1,2 IgG serology and HSV IgM W/RFX titer. HSV IgM was detected, titer 1:10 whcih is the reference range for positive. IgG were negative.
I have had VZV as a child and EBV as an adult but years ago. 5 months ago I had a weeklong febrile illness with night sweats that was qualitatively similar to EBV but I had no serology.
1)My question- Quest diagnostics states that there is cross-reactivity between HSV IgM and VZV,EBV,CMV, but would this cross reactivity occur years after VZV, EBV, etc.
2)Other question, what is the time frame over which 100% of patients have IgG seroconversion?
3)Last crazy question- since this is on my lower abdomen, the dermatome has a direct path around my torso---> since the reactivation is travel along the nerve from the dorsal root, could abdominal recurrences be prevented by disrupting the nerve path, such as with a paraspinal full thickness skin excision, so that future recurrences would occur on the back instead?
Doctor's Answer
by Alan Rockoff, MD, Apr 14, 2005 12:00AM
, Apr 14, 2005 12:00AM
1. Sorry, but I don't know. You'd have to ask Quest.
2. Usually 3-4 months. Again, please ask Quest.
3. Herpes of the penis can sometimes recur next to the sacrum.
However, your lesion is on the abdomen, not the penis. Also, if you were just now infected, you'd have fever, swollen glands, etc. Also, you describe 1 vesicle, not a grouped cluster.
In other words, the clinical picture doesn't fit herpes. I advise you to get another blood test in 3 months.
Take care.
Dr. Rockoff
2. Usually 3-4 months. Again, please ask Quest.
3. Herpes of the penis can sometimes recur next to the sacrum.
However, your lesion is on the abdomen, not the penis. Also, if you were just now infected, you'd have fever, swollen glands, etc. Also, you describe 1 vesicle, not a grouped cluster.
In other words, the clinical picture doesn't fit herpes. I advise you to get another blood test in 3 months.
Take care.
Dr. Rockoff
