Confusing IgM & IgG Tests

Hello everyone. I was "diagnosed" last year as having genital herpes.  I had had a sore clitoris for about 2 or so months and thought it was a yeast infection. Had a yearly ob-gyn checkup (had the sore clitoris but didn't mention it at that time) in March (2010) and was tested in May (2010 - approx 2 mths later) for GH via blood and culture due to the sore not going away. I was told I was positive for recent GH infection, but am totally confused as to how. I have been married for 10 years and neither of us have slept with anyone else (of course anyone can lie) but I do believe my husband..for now. The reason I am confused is here are the results:

HSV I IFF, Type Spec    4.32 (Abn: H)
HSV 2 IGG, Type Spec  <0.91
HSV, IGM I/II           2.56 (Abn: H)
HSV Culture/Type       Result:  COMMENT

The blood tests were drawn with what I was told was an active lesion, should the HSV 2 not have come back as positive for SOME antibodies if indeed I was HSV 2 positive or could this just be a HSV 1 lesion obtained via oral.  My husband has been tested for HSV I/II and is negative on both counts.  I have had the complete STD panel and negative on all counts including HIV and syphllis.  I am 38 y/o and healthy. Since my "sore" was diagnosed I was started on Valtrex 500 mg twice a day, no results, moved to 2-4 500 mg. in Nov. 2010 as well as Zovirex topical cream, STILL continued with what appeared to be active lesions constantly, and quite frankly over a year of what was one cotinuous outbreak with NO disappearance of soreness and sometimes a visable small lesion or two.  Never a covering of blisters or anything on my vagina, just mainly the clitoris area.  I went for my yearly OB GYN checkup in April 2011 and was finally started on Acyclovir 400 mg, twice a day (30 days) in combination with 1 gram Valtrex twice a day (10 days) and seem to FINALLY be free of my nemesis but only after I was confirmed to not have any immune compromised condition.  My question, how could my HSV II type specific antibody come back negative after what I have been told was an active outbreak.  Please help, I am so confused.

[gracefromHHP]

evidently your provider diagnosed you as having genital herpes based on a + igm test result. The herpes igm test is a flawed test and currently CDC herpes testing guidelines are that it's not to be drawn on adults because it's falsely positive far too often.   Encourage your provider to update their herpes testing knowledge before they get sued for malpractice.

At this point, I really recommend that you stop all herpes antivirals. There's no reason to be on them.  If you get a return of symptoms, be seen within 48 hours of the appearance of them for a lesion culture and typing. Herpes would not be active for that long and on antivirals and not clear up. It's doubtful that herpes is what was causing your ongoing genital symptoms.  

have they been properly testing you for yeast and bacterial infections vaginally when you were seen?

grace

[gracefromHHP]

evidently your provider diagnosed you as having genital herpes based on a + igm test result. The herpes igm test is a flawed test and currently CDC herpes testing guidelines are that it's not to be drawn on adults because it's falsely positive far too often.   Encourage your provider to update their herpes testing knowledge before they get sued for malpractice.

At this point, I really recommend that you stop all herpes antivirals. There's no reason to be on them.  If you get a return of symptoms, be seen within 48 hours of the appearance of them for a lesion culture and typing. Herpes would not be active for that long and on antivirals and not clear up. It's doubtful that herpes is what was causing your ongoing genital symptoms.  

have they been properly testing you for yeast and bacterial infections vaginally when you were seen?

grace

[ISEEKHELP]

Thank you so much for your response.  I am so confused and frustrated.  I do go this Thursday (4/14/11) for some bloodwork (I have the 2 hr blood glucose test d/t a test of 106 fasting) and I requested another IgG type specific test be conducted. If indeed I was to have HSV GH infection it has been a year since "infection" and antibodies would surely be present by now.  I cannot imagine the h***l I've been through the last year with constant pain and lesion and thinking I have GH only to find out that I'm negative for HSV II.  Obviously I am high on HSV I based on the IGG but hey that could be from previous exposure to chicken pox I presume as I have never had a cold sore.  I guess what confuses me is if it is HSV I but genitally, how the heck it got there since my husband was tested this past Friday and his bloodwork IGG for I and II is NEGATIVE. Seems my gyn dx me based on the IGM test and my lesion and said I was not positive for Type II IGG test because I had recent exposure in the last 7 days to 12 months! HUH!  

[ISEEKHELP]

Can I again say how thankful I am for your knowledge and response.  When I say the last year has been emotionally hard and physically draining is a MAJOR understatement and I didn't know the actual lab results/numbers until last week. I was told over the phone in May of 2010 via my gyn's nurse that I was positive for herpes and started on the Valtres, which like I said I have been on for over a year with upto to 2 grams of Valtres daily with continuous "outbreak" symptoms...itching, tenderness, pain, crawling like discomfort.....I appear to have all the classic "symptoms" but no bloodwork that is positive...so far.  Again, I was told that my HSV II IGG didn't come back positive because I had recent exposure but woudln't my HSV CULTURE not say positive for Herpes simples instead of COMMENT under RESULT?  These test were performed by LabCorp in Burlingon.  Also my husband and I have had sex during the past year and he is not showing any infection via IGG bloodwork either.....after a year he should have at least contracted it...unless of course the Gods are merciful!  LOL  I am afraid to hope that maybe I had a false positive diagnosis due to my last year of symptoms and confusing test results of the HSV CULTURE being COMMENT and my dr. saying I have GH!!!

[Mistakeguy789]

Chickenpox and HSV are different viruses.  They have different antibodies.  Your doctor is a little confused on the testing for HSV.  IgM is not to be used for the reasons grace said.  Herpes testing for IgG isn't looking for chickenpox.  Therefore you have to worry less about that being the case.  You could have had HSV-1 orally and just never remember having a cold sore.  

Following the advice grace gave you is the best step.  The "comment" would need to be looked at.  At this point you need to be seen within 24-48hrs after symptoms come back again and have the doctor do a swab and either send it off for HSV PCR or culture with typing.  Also request they check you for yeast and bacterial infections as well.

[gracefromHHP]

It's unfortunate that you didn't find us sooner :(


keep us updated as to what you find out :)

[ISEEKHELP]

Thank you so much for your advice and knowledge.  I will know more after the results come in from Thursday's bloodwork since I will insist on another IGG NOT an IGM test be performed.  And trust me, I WISH I had found this forum before a year had passed.  I would have been back in my dr's office months ago insisting on another IGG test.  It always bothered me that my symptoms never really seemed to respond to continuous 2 gram Valtrex (since mid Nov. 2010) meds as well as putting the Zovirax cream on what lesions I saw.  Talk about misery and frustration!  And then reading more and finding that continuous herpes breakouts is usually caused by HIV...ANOTHER worrisome weekend waiting for results!  The discomfort has always been there.  Every itch, every discomfort becomes worrisome of "Oh no....here we go again..." Kinda like as soon as one place would clear up, something would pop up in another area.  Thank you, thank you, thank you for responding!!!!!  :)