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IgM and IgG confusion
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IgM and IgG confusion

Hello Dr.

I just got diagnosed with Herpes, although I have my doubts.  I have had no sexual contact within the past 5-6 weeks (possibly more than that, i cannot quite remember) and the results concluded that I only have IgM antibody present in my blood.  This is what my results look like:

HSV 1/2 IGG, Herpeselect Type Specific AB
Herpes Simples Type 1- 0.93
Herpes simplex Type 2- 0.09

HSV IGM Antiobody W.Refl titer
HSV IGM Antibodies were detected/ Ref. range was not detected
HSV IGM Titer was 1:20

What does this mean?

In addition to that, is there any way to tell wether I have type 1 or type 2?

Should I get tested again soon?  The Doctor put me on Valtrex and told me to do a follow-up in two months (I think that is only for my liver/kidney analysis).  I have been reading alot about the virus and the presense of IGM without IgG...could this elude to another infection.  Do I really have genital herpes?  What do you suggest?  How long does it take for IgG to become detectable?  How long does IgM remain detectable?  

Please help.  I appreciate your time.

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101028_tn?1348750963
Did you have any genital lesions or did you just go for the blood work and based on that you were told you have herpes?

grace
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Avatar_n_tn
I may have had lesions a couple weeks prior, I over-looked them as something else, it was just irritation...the last time I was sexually active was at least 6 weeks ago...in March.  I decided to get blood work done because I had never done it before...and those were the results I got...

Your thoughts?
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Avatar_f_tn
Um...I don't think actual Drs answer questions on this site...I might be wrong tho.

Anyway, as I said to another member...I was told there can be false negatives but no false positives. Also HSV can lie dormant and you may not show symptoms for a long time. You can also pass the virus to others even when you don't have an outbreak. These are all things I was told by my Drs and things I read online.

I don't know what IGG or IGM are tho. It might be a good idea to go back to your Dr for more info.
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101028_tn?1348750963
Your igg blood tests are negative. Chances are good you would've seroconverted by now but if you need the peace of mind - wait and repeat your igg blood test in another 6 weeks.  should you get a return of the irritation - see your provider for a full exam and testing then.  I have absolutely no idea why your provider put you on valtrex - there's no need for it at this time.

Disregard the igm result. It's not to be used on adults for herpes testing/diagnosis.  

grace
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Avatar_n_tn
How long is it before IgG is present in the blood?  I read that it is 4-6 weeks before you see IgG...is this correct?  Would taking ValTrex change my results or the onset of IgG?  

You say disregard the IgM test?  Why?  Doesn't it indicate acute infection?  Why do they use it?

Of course I am paranoid now and everything I see or feel is an "outbreak" to me.

What do my results above indicate?  

Thanks for your help!!    
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Avatar_f_tn
I'm going to repeat here what I said to another member because I gave some incorrect information...which was initially given to me by my Dr. It really bugs me now knowing that the Dr didn't know what the heck she was talking about! I did some searching and found these stats...

The current test used by our laboratory service gives a positive result in about 5% of people who do not have HSV infection (this is called a false positive result).


The test will give a negative result in 15% of people who really are infected with HSV (this is a false negative result).

from this site http://www.stdservices.on.net/std/herpes/serology.htm

and this...
Some so-called type-specific EIA tests which are reported as "type 2: type 1 ratios" are not truly type specific.3 Thus, a patient with an oral herpes simplex type 1 infection may show a false positive result for type 2 on some testing.

from this site http://www.herpes.org/herpesinfo/diagnostictesting.shtml

I stand corrected...and so does my stupid Dr! There are false positives as well as false negatives. How bloody annoying is that?
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Avatar_n_tn
so what the heck do you believe?? and WHO do you believe?  Do you know when the IgG antibody should show up?  I am getting retested in a couple of months...If i am IGM negative and IgG positive...does this confirm herpes?  Thanks for all your insite.
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101028_tn?1348750963
Who can you believe? Well me of course! No honestly I take great pains to be as up to date as possible on herpes and I'm not making any of this up.  etc if you take absolutely nothing else away from this board - remember that the igm herpes test is not accurate and should never be drawn on you ever, ever, EVER again. Got it?  If you feel the need for more reading - search for igm herpes testing posts by HHH - he's covered this so much he won't even type as much as I do on it at this point.  


How long is it before IgG is present in the blood?  I read that it is 4-6 weeks before you see IgG...is this correct?  Would taking ValTrex change my results or the onset of IgG?  

- in about 1/2 of folks it's present by 2-3 weeks after infection.  Some folks take up to 6 months but the vast majority of folks are testing accurately by 3-4 months post infection.  taking a round of valtrex won't affect your results - there is no reason for you to be on daily suppressive therapy since at this point all signs point to you not having herpes.  

You say disregard the IgM test?  Why?  Doesn't it indicate acute infection?  Why do they use it?
- it's not accurately type specific even when it claims to be; it can be falsely + due to other viruses and due to other herpes virus infections; it also frequently reactivates during recurrences of hsv so you can't rely on it to be an accurate indicator of a newly acquired infection either.  Why do they use it? Because most providers are not up to date on herpes blood testing and don't even know that it's not like other igm blood tests are for other infections.  

Of course I am paranoid now and everything I see or feel is an "outbreak" to me.
- put down your johnson dahlin, walk away from the computer for the next 6 weeks and go about your day as usual.  The more you worry and obsess - the more you'll "feel" down yonder.

What do my results above indicate?  
- as I've already said - your test results are negative.

grace  
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Avatar_n_tn
Thank you grace,  easier said than done.  I am in a situation that makes this complicated and I really appreciate your input.  It is funny, I have called my doctor a few times and the more I question her the more I doubt her.  For example...she didn't even request a re-test on my HSV status...just on my liver/kidney counts...I had to request that I get retested in July.  Is this odd?  And I asked that if she knew what type I was...she said since you already have a sign of HSV-1 and this is a 'new' infection...we assume it is HSV-2.  Assumption??

I really want to believe you 100% and I pray to god that you are right...but when a Doctor says that you have something...we are conditioned to believe it.  Although i am doubting it more and more...I am still going to find it difficult not to think every single thing "down" there or anywhere is an outbreak!  

Why don't doctors educate themselves on these issues.  

What other viruses would cause an acute raise in IgM count?  It looks like I could have HSV-1, but I haven't had a cold sore in years.  

Thanks again for all your help, my mind is starting to "ease" a bit.  Trust me, i was in a full fledge panic!

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101028_tn?1348750963
Even your hsv1 is negative though that's not unusual even if you do have a history of cold sores.  Even the best tests we have still miss 1 out of every 10 hsv1 infections.  When you last had a cold sore - was it on the outside of your lips or in the inside of your mouth?

You only had irritation - it might not even be herpes.  Not sure why your doctor is insistant that you have herpes.

grace
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Avatar_n_tn
I think the last cold sore I had was on the inside of my mouth...i cannot even recall one on the outside since i was a child/highschool.  

Yes, I had irritation (just on one side of my vulva)...and it was right after a sexual act and right before my period.

I exercise alot and a little over a month ago I had a urine analysis and it came back positive for protein in my urine...I got retested at the same time I got the STD test (5/5/08) and the UA came back negative at that time but IgM detected.  Could this be indicative of anything/do they correlate?  

I thought I may have had a UTI infection or something at the time/just prior of the first UA and PAP (march 20th) (mainly because my "symptoms"/ sexual act were right before that)...and then decided I would get STD tested at the second UA date (5/5), for a peace of mind (never had before)...so much for a peace of mind!!  You are definately helping though, and I really appreciate your insite...it will be tough waiting two months for another exam.  Should my partner get tested?  

and you are right...the more I think about it...the more I think there is an irritation/tingling...ugh...am I making this up now??
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Avatar_n_tn
hi grace

Since you seem do have a good understanding of this matter I was wondering if you could help me clearify my problem.
I aquired genital HSV-1 3 weeks ago (found out through culture test)
And I know that once you have the antibodies you are almost immune or at least very resitant of spreading the virus to other parts of you body or aquiring a new HSV-1 infection from someone else.
My question to you is how much of a risk could I be in of aquiring HSV-1 orally or a new genital infection if I have intercourse or oral sex with another genital HSV-1+ lady that just aquired HSV-1 too?

As I read it too, If you recenty got exposed to the virus you build LgM antibodies until you build LgG antibodies.
But will the LgM ones protect me now untill I build LgGs?
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101028_tn?1348750963
sounds more like you had canker sores - not cold sores.  Canker sores are more typically inside the mouth area. They are not contagious.

irritation is common. I know it's hard to believe but really sometimes it really is just irritation and not something like herpes.  Have they tested you for yeast and bacterial vaginitis at all since the first u/a when you thought you might have a uti going on?

grace
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101028_tn?1348750963
If you have genital hsv1 and your partner has hsv1 genitally too - nothing to worry about. Just don't perform oral on each other when you have active genital symptoms just in case either of you were lucky enough not to have contracted hsv1 orally at the same time too ( we don't have good stats on that but chances are good that either of you might've even if you didn't get obvious cold sores - that said - it's not an issue since you both have hsv1 already in your bodies ).

Now go have fun!

grace
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Avatar_n_tn
No, they didn't test me for a UTI...they just did the Urine Analysis and it came back negative.  

I would like to get retested sooner than July...would you recommend any place?  I feel like the IgG antibodies should be present by now if my last exposure was in the beginning of March...would you agree?  

Curious...do lesions usually show up at the point of contact?  So if you vaginal sex, do lesion usually occur on or around the vagina?  and...i also read that they are bilateral...is this usually true?  Do all blisters break and then scab over?  I have never had a scab "down there" before...

so many questions...
You are so great!  Thanks Grace!
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101028_tn?1348750963
Lesions can turn up anywhere in the entire boxer short area.  Sometimes they are near the point of contact - sometimes they aren't.  Same with they don't have to be bilateral either with the first ob. Usually recurrences aren't bilateral but I've even found that to be untrue sometimes.  

As for scabbing over - lesions in the genital area do not scab in the same way say a skinned knee does. It's not that obvious of a scab.

Why not repeat the blood test now?  it's 2 1/2 months - pretty darn close.

grace
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Avatar_n_tn
Thanks grace for the quick response. I apreciate your help.

haha and sorry I can see you are getting bombed by responses.

I though if either of as already had HSV-1 orally it would have been very hard to get HSV1 genitally so I suppose we both dont haven it before.

Juts to confirm your statement. I aquired it three to four weeks ago. So I have to assume I will not have antibodies (LgGs) yet and so wont she.
Considering that, would you stick to the information you responded?
Because I am afraid of her and me reinfecting herself/myself genitally or aquireing a cold sore.

Thanks again.
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101028_tn?1348750963
Nope - a month ago is fine. You started developing protective antibodies against herpes from the moment you were infected.  btw it's igg and igm - not lgg and lgm ;)

You won't make it worse in each other or anything like that!

grace
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Avatar_n_tn
Thanks again Grace you seem to be very helpful to this forum

But why do many people are supposed to wait longer than one month do to a blood test?
As I read in articles that it sometimes takes 3 months untill you build IgGs.
How could her and my body for sure be protected already? Is that where the IgMs come in?
I am not questioning you, it just needs to come logical to me in order to sett my mind.
I hope you understand. Thanks a lot.
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Avatar_n_tn
Grace,

Do you think my IgG's should be in the blood now if I am positive?...i mean, i am a pretty healthy person so I would think that all other things should run according to "normal".  Like antibody response and stuff like that.

How would I go about getting retested now...my Doctor has written me a request 2 months down the road.  Is there any way I can just go and request it myself?  Any Suggestions on where to go that is reliable...

also...are you more susceptable to Herpes if you have your period and perform sexual acts??
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101028_tn?1348750963
You aren't more susceptible just because it's that time of the month.  That's blood coming from the uterus - not blood coming from an open cut/scrape etc.  As far as I know they've never looked at anything like that though.

Why not give your doc a call and ask if you can move it up because you dont' want to wait 4 1/2 months total to test?  otherwise you can check around at other clinics or if you are in the US you can order your own herpeselect igg for hsv1 and hsv2 up thru www.tstd.org or www.healthcheckusa.com   for about $100 ( just call the 1-800 number at tstd to order the herpes test specifically ).

grace
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101028_tn?1348750963
There are several different types of immune responses. The herpes blood tests look specifically at the igg response and need time to until they can detect it.  For some folks this is as little as 2 weeks post infection.  

hope that helps!

grace
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Avatar_n_tn
thanks for the information.

you have been of great help to me...I really hope the next test comes back negative!  Do you think my partner is at risk?  

I swear...this is the last question for awhile...you are right...I have to get away from this dang computer and issue...
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101028_tn?1348750963
come help me wash the dogs :)

grace
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Avatar_n_tn
I owe you at least that...haha.  Thanks.
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