Igg vs Igm (Do I defintely have Herpes)?

[JA40]

Hello Dr.'s,

I've seen several posts about Igg vs. Igm HSV testing and am 100% clear on Igm being inaccurate, worthless, etc. in finding out if an individual actually has Herpes 1 or 2.  A type specific blood test such as HerpesSelect is recommended by the CDC (Center for Disease Control) and I understand they (CDC) actually discourage Igm tests as well.  Before getting to my actual questions and concerns I wanted to describe my situation (i.e. potential Herpes symptoms)

I developed Herpes related symptoms about 2 weeks ago which began with a burning sensation when urinating...sometimes at the onset of of urination, sometimes during, and sometimes after.  I was tested (urine) for Chlamidia and Gonnorea (sp.?) the same day of my symptoms which came back negative.  About 4 days later I still had the burning sensation while urinating and went back to my doctor.  He gave me another urine test (negative again for Chlamidia and Gonnorea) so he diagnosed me with Urethritis and gave me a shot of Recophin in my butt and one dose (4 pills) of Azithromycin.  Two days later the pain while urinating was extremely better (from the antibiotics???), but I then developed a small scab on the shaft of my penis followed by another 3 scabs within about 20-30 minutes so I went back to my doctor... these were not blisters or open sores and still aren't...they literally developed as scabs before being an open blister or sore.  I know this doesn't make much sense, but being the obsessive compulsive individual that I am I would've noticed blisters or open sores on the shaft of my penis since I was constantly examining my genital area every hour or two due to the burning sensation while urinating.  My doctor thought it was most likely Herpes and ordered a blood test and prescribed Valtrex.  The scabs have been around now for about 5 days and are better, but still there.  No pain at all around the sores/scabs, no new ones have developed, and the burning while urinating is completely gone.

I received my blood results today and my doctor believes I have Herpes due to my string of symptoms and positive Igm blood test.  My Igg for both 1 and 2 is negative. So my first question is do I most likely have Herpes?  I've been told that in about 90% of Herpes cases in men the scabs/sores are very painful...again I have no pain???  Also, the burning in my urination seemed to get better from the antibiotics and is completely gone...the antibiotics wouldn't make Herpes symptoms better, correct?  And again, the scabs/sores are still there but definitely better and still no pain.  I have not begun the Valtrex medication because I'm not certain I have Herpes since my symtoms are better.  All of this coupled with the fact of a postive Igm for antibodies and negative Igg on Herpes 1 and 2 has me confused.

I understand Igm testing has been known to detect "early phases" or "recent" infection of Herpes, but several threads on this site say to disregard the Igm completely...would you suggest I still dismiss this test given my symptoms?  Could it be anything else? Some sort of other infection...maybe male yeast infection? Or some sort of skin condition coupled with urethritis?  Could the antibiotics in my system (Recophin and Azithromycin) be causing the positive Igm?  

My girlfriend just took her blood test and I believe it's a HerpesSelect so Igm will not be tested.  Needless to say I'm trying to figure out timing concerns and if I do have Herpes if she infected me with the virus.  We've been in a monogamous relationship for 7 months and I haven't been with anyone else.

If she tests postive on the HerpesSelect Igg she obviously could have been a carrier for quite sometime without any symptoms and never knew she was infected.  In this instance given my negative Igg and positive Igm if I test later and come up with a positive Igg she would be the individual who infected me, correct?  If she tests negative like I did on the Igg we both plan on being re-tested in about 3-4 months.  If at that time we both test positive would it be safe to assume she was infected by someone else during the first 7 months of our relationship?  I say this because one of us would've had to contact it somewhere and I most certainly haven't been with anyone else but her.

Thanks in advance for the response.  Anyone else out there please respond if you can add some insight...appreciate it.

JA      

[scared_half_to_death]

This post is way too long...

The best thing to do is have your lesions cultured for viruses. The testing should also include the HSV type, if it positive for herpes. If your culture is negative, you should still have a type specific test like HerpesSelect.

Herpes can take 3-4 months to show up on a HerpesSelect test. However the median is approximately 20-25 days. You might get tested at 6 weeks, if negative, get tested again at 3-4 months.

The same holds true for your girlfriend. If you have not had any other sexual contact in 3-4 months AND you are Herpes positive in your genital area, then it is likely that you caught it from her. However, it seems that she does not know that she has it, so who cares where it came from?

[gracefromHHP]

It's way too late for a lesion culture ofyour symptoms - they are already scabbed over.  You know your baseline blood test was negative so it's not likely that this is just your first obvious recurrence of a prior genital herpes infection though it could be a hsv1 infection genitally that isnt being detected on the blood test.  Should your symptoms reoccur at any point - ask for a lesion culture and typing to be done then - preferably pcr.

Once you know your gf's status I think you'll have better answers about all this. If she's just hsv1+  then I don't recommend either of you repeating your blood tests for this.  Even if you repeated your blood test in a few months and it came back as hsv1+ - there's no accurate way to determine if that's a hsv1 oral or genital infection.  The only accurate way to diagnose hsv1 genitally is thru a lesion culture and typing of active symptoms. If you would happen to have hsv1 genitally and she has it orally - just avoiding sex during obvious genital symptoms is all it takes to protect her so it's really not an issue anyways for the 2 of you.  If she tests + for hsv2 - then repeat your blood test in a few months or get a lesion culture if symptoms return. If she tests negative for herpes completely - I still wouldn't bother repeating the blood test on either of you.  Just abstaining from sex during obvious genital symptoms is still a darn good way to protect her.

could this all be something bacterial that was cleared up with the antibiotics you had? Sure it could be.  It could even be something completely unrelated and the timing of healing of symptoms was just coincidence.

grace

[JA40]

Thanks for the response Grace...obviously I'm quite concerned about this and am having difficulty focusing on other areas of my life right now.  It was my understanding that hsv1 is oral herpes and hsv2 is genital.  You mention abover that I could have an hsv1 infection genitally...how could that be...wouldn't a genital infection always be hsv2?

My gf hasn't had cold sores in about 6-7 years, but she did get them as a child up until she was in high school.  Since then she hasn't showed symptoms or visibly seen a cold sore.  However, her college bf did get cold sores a few times per year, but again she hasn't shown any recent symptoms.

I have a feeling her hsv1 is going to come up positive due to her previous occurences of cold sores even though its been quite sometime.  So you're ultimately saying 3 months from now (or even in a few days) if she's positive on hsv1 and negative on hsv2 its possible she could have infected me with her hsv1 on my genitals and I could test positive for hsv1 on my genital area?  And is it possible if I ultimately test positive for hsv2 that her hsv1 could have transferred to hsv2 on me without infecting ever infecting her of hsv2? I guess I'm confused because as I mention above I thought it was fairly clear cut - hsv1 is oral and hsv2 is genital.

One last question, I promise! :-)  So if we're both negative now on hsv1 and hsv2 and retest in a few months and one of us has hsv2 or hsv1 genitally is it safe to assume one of us was unfaithful and our negative tests were simply because the virus didn't have enough time to show up positive on a blood test?

I'm obvioulsy praying this is/was something completely bacterial and we both test negative now and in a few months if we decide to test again.  Thanks so much for your help and answers Grace.  Are you a doctor/nurse?  

[gracefromHHP]

I played a lot of doctor growing up ;)

No- hsv1 is not always oral and hsv2 isn't always genital.  Check out the herpes handbook at www.westoverheights.com for more info on herpes.  And yes you know your gf has hsv1 orally and even though she hasn't had an obvious cold sores in ages - she is still periodically shedding the virus and can transmit it to either your oral or genital area. As I said - it would take a lesion culture and typing to accurately determine that though.

You haven't had other partners. No reason to retest for either of you in the future unless her blood test comes back as hsv2+ then you will need to repeat yours in a few months.

grace

[inatizzy30]

HSV1 is very easily transmitted oral to genital, and then genital to genital. It is always good to have a negative IGG test redone several months after exposure, just to be sure. Chances are your girlfriend has been an HSV1 carrier for years. HSV2 - maybe a little more complicated for the relationship.......

[gracefromHHP]

His gf has a history of hsv1 orally - that was already stated.

also no it is not that easy to transmit hsv1 from genitals to genitals.  Even oral to genital transmission isn't all that easy even though the rates of infection of hsv1 genitally would seem to point to otherwise.

Maybe back off the gloom and doom a little in your responses?

grace

[JA40]

The "gloom and doom" of her having HSV2 isn't all that concerning.  I can live with that since it could very well be that she's had HSV2 for quite sometime and not shown any symptoms.  I'm just concerned about what's been going on the last seven months or so.  If she comes up negative on the HSV2 now and then we both retest in 3 months and we're both positive one of us would have to be hiding something, right?  Because as of now all I have is a positive ("detected") igm test and negative on the igg for 1 and 2.  I'm assuming she will be positive now for 1 due to cold sores, but if negative now on 2 and then positive later along with me getting a positive 2 this would be cause for serious concerns, correct?  I know it's all speculation now, but it's really eating at me.  Don't want this to bother me or put crazy thoughts in my head for the next 3 months...

I'm still holding out hope for not have Herpes at all since my 1 and 2 on the Igg came back negative, but my "potential" symptoms are bothering me and I'm starting to think it's false hope.  Most recently I've started to feel a dull shooting pain in the head of my penis for a few seconds at a time about 3 times per hour.  I'm also thinking this most recent feeling may be stress and anxiety related.  There also seems to be ian ithcy or burning type feel on my inner thighs and genital area.  

Everything else I mention above has seemed to get better without any meds which is what is giving me some hope.  The burning in my urination stopped about 2-3 days after receiving the antibiotics and the 4 scabs on the shaft of my penis have never hurt or been open sores.  The reddish color under the scab also only lasted for about 12 hours.  They are very strange and as I mention above showed up 1 week after the burning urination started.  They also came on within about 1 hour.  Don't the sores usually come first?

Could this be syptoms (symptoms) of anything else?  Balantitis, yeast infection, prostatitis, some sort of skin infection?  I've also had weird things come and go on my penis.  The other day I woke up and there was a bunch of dry skin on the head of my penis...like it was peeling.  Also saw a white patch a few days back that seemed to have some sort of texture to it...all of this stuff seems to disappear and not come back though.  Am I going crazy???    

[gracefromHHP]

sorry you got confused - the gloom and doom reference was not to you.  I had addressed that comment to the other poster.

grace

[JA40]

No worries Grace.  Any other insight to my questions or concerns?  Should I assume I have Herpes or could this still be something else?  Again my Igm was "detected," but negative on HSV1 and HSV2.  Should I still ignore the Igm results or are my symptoms consistent with Herpes?  

My gf's results came back today and as suspected she is HSV1 positive and HSV2 negative.  How likely could it be that I received HSV1 from her on my genitals?  Is this common or not all that usual?  She has not shown any symptoms so I'm just wondering how likely this is...  

I'm most concerned about our retests in 3 months and if one of us comes back positive for HSV2.  That would obviously mean one of us has been unfaithful since we are both HSV2 negative now, correct?  Please answer all of my questions and concerns if you can.  Appreciate it!  

[kklang27]

hi, i am female and 25yo. i had been diagnosed with hpv or genital warts last october 2007 and was treated with cauterization. then i got tested for other stds all of them were negative. except for my result on the Herpes type 2

It read that:
herpes type2 IgG 0.07 negative
Herpes type2 IgM 1.03 equivocal

then recently about two days ago, ia had protected sex with my boyfriend. this the first time we had sex again after i was diagnosed with the HPV/ genital warts. so almost 6 months had gone by and i did not have sex at all. after 2 hours, i noticed that there is a small cut on my  vaginal opening. it did not bleed nor it hurt when i pee. the cut was really small. like about a 1mm. it was only red and i did not have burning sensation when i pee, no itching, no nausea, no other symptoms. i kind of thought that it might have been because it is the first time that we had sex again after i was operated on, the time he inserted his penis it kindof hurt and we stopped. like i felt like a tear or something. then i emailed my doctor and he told me based on the results of my Herpes tests i should have the cut tested becuse i tested equivocal on my HSV type 2 IgM. so im kindof confused...thank you so much for your input about this.:D

[gracefromHHP]

you should've just started your own thread - it keeps it less confusing.

The igm can not be used to diagnose herpes.  Has your bf been tested to know what his hsv2 result is?  

grace