please help read lots from this forum still have questions

[anxiousconfused85]

hello dr,

My question is about the HSV IGM. (and yes I've read the previous postings).

i have been in a monogamous relationship for a couple years. Yearly, when i go for my pap, I request to be tested for all STD's. Every year i am tested, every year i am negative. Two weeks ago i went to my general practitioner for rash i had on my lower back. Doc was unsure if it was shingles or impetigo. i was treated for both with Valtrax for shingles, and bactrim ds for staph/strepp. I also requested a diflucan because i am sensitive to antibiotics, every time i take them i get yeast infection. I i took all 3 Rx at once. Within 2 hours I could feel a yeast infection coming. I got a monistat and thought that would take care of it. 4 days later no relief from the yeast. Shingles/strepp/stapp was getting was getting better.  i went back to the doctor who was happy to give me another Rx for difucan. I thought maybe it could be BV because the monistat wasn't working. i asked her to take a look. She said i was completely raw and that there was a tear in my labia that could be from yeast or HSV. I asked to be tested for all STDs while she was there to make sure i wasnt having a more serious problem. We went back and looked at my previous lab results from prior years and the only testing i had never been given was the HSV tests. She said it wasn't ordered because i never had any symptoms. Order some blood work and gave me a Rx for difucan, yeast infection cleared up.....
Test results in.... Clear for all other std testing. Except HSV... Results as follows

1)  HSV type 1&2 IGM:
       herpes simplex type 1 IGM:
         HSV Type 1/2 IGM antibodies= 2.12 index  (ref range= <0.90)

2)  HSV Type 1&2 IGG, Herpes Titter
       hsv1 IgG indicates +
       hsv2 IgG indicates -

3) Hsv IGM antibodies IFA
       HSV1 igm abs by ifa detected
       HSV2 igm abs by ifa detected


Here's my confusion from all post i read and from cdc.... the IGM not accurate because it can 1) give a false positive and 2) CANNOT distinguish between the two viruses, 3) does not tell if it is a new infection just that there was an recent outbreak. MY IGM are written out in a way that looks like they are distinguished. To me these results look i am IgG reliably positive for HS1 (though i have never had a cold sore or bump unless it was that yeast thing). IgG negative for HSV2. What is scaring and confusing me is that the IMG results came back positive for both. I typed them exactly the way they were written.  Is it possible that my shingles made a false positive read for IGM HSV2?
And has testing come along for img that it can now distinguish. i feel like there are a lot of variables here.

[Terri Warren, RN, Adult Nurse Practitioner]

Your test indicates to me that it is a combined HSV 1 and 2, not a type specific one, because there is no truly type specific IgM testing! This means that if you have HSV 1 OR HSV 2 antibody for IgM the test will look posiitve (the reality is that it can be there even if neither is present, because there are so many false positives on this test).   That's all there is to it.  I know you are worried and scared and upset, but this test is just not reliable.  You will need to rely on type specific IgG testing.  I'm not clear if your partner has or has not been tested for HSV IgG for HSV 2.

Terri

[anxiousconfused85]

hi terri,

Thank you for your prompt response. My anxiety is starting to take over.  

No swab tests were taken of my back or labia. just a blood test after i requested testing at followup visit for yeast infection. Doc said she didn't do a swab of my labia because i didn't have a blister, just a tear and to swab the skin would just culture stapp or bacteria present in the vagina or rectal area.

i received 3 results and typed the test results as they were written above:

Test 1) looks like a combined test in the title of it but results were given with only HSV1 as a label. Being that it is an IGM i don't understand how they could do that

Test 2) positive for HSV1 IGG. negative for HSV2 IGG. I can accept that even though i have never had an outbreak or a blister or anything. no tingling no symptoms, i know that most adults do have HSV1 and got it from when they were a baby and mom and dad aunts and uncles kissed you. i guess I'm just lucky i don't get cold sores. And as far as HSV1 genitally I've never had any signs. no bump or pain or muscle soreness.

Test 3) This is the one that is getting to me emotionally. IGM detected for BOTH hsv1 and hsv2. How is that possible??? i thought the test could not distinguish between the two viruses. So how could the test results be labeled as such? Has there been new advancement in igm testing that now a test can determine hvs1 and hvs2? (And again, i had shingles at time of testing, perhaps the results were crossed which is my hope).

Bottom line, i have never had any reason what so ever to suspect that i had hsv. until my doc took a look at my yeast infection and mentioned i was completely raw and saw a small tear in my labia that could potentially have been from HSV. So i asked to be tested for it along with other STDs since they were drawing blood anyway.

As far as my partner, when we decided to have sex, we were both screened for STDs. Both negative. My partner has never shown signs of outbreak. I don't know if partner was tested for hsv because I wasn't. Reason given to me was that i never exhibited any of the signs for it. So no test was ordered when i requested STD screening. i am hesitant to bring this up to my partner as i feel like there are too many variables at this point ( IGM could be false positive HSV2 because of shingles or past HSV1). I am looking for some clarifications before i put my partner though the potentially wasted emotional trauma that i am going though thinking i may have HSV2.

Received an email from my Doc. Email stated that the results are hard to read or interpret and that i won't be put on any medications (valtrex ect) because i have never expressed any signs of hsv.

Don't want to have hsv and would be happy to dismiss test results, but i am trying to be a responsible sex partner.

Also, do you suggest going in a month or two to be retested ONLY by IGG?


thank you and sorry if i overloaded you on info. you response will be much appreciated.

[Terri Warren, RN, Adult Nurse Practitioner]

Were any swab tests taken for HSV or shingles, do you know?  All I see here is blood work.  

To me, it looks like the IgM is a combined test, not separate, although you have a 1 in there, just before the IgM, that doesn't fit with the rest of the line about the IgM.  

Has your partner been tested for herpes?  If your partner is negative for HSV 2, then there is no worry about you getting HSV 2 unless your partner has had a new partner that you aren't aware of and testing may be done too soon to reflect his antibody status accurately.  

If you are both truly only having sex with each other, and he tests negative for HSV 2, then you don't have new herpes type 2.  I suppose it is possible that you have new HSV 1 infection genitally, however, depending on the exact timing of the testing.

Terri