Igm Testing

Hello Doctor,

I recently went to my OBGYN to do an annual test for stds.  Everything came back fine.  Last Friday the medical assistant called me and said that "I might have herpes."  She said my test came back a low positive and that I should be retested again within 3 months just to make sure.

I requested that I speak to my doctor.  She told me that she highly doubts that I have herpes because the results could be due to a different infection such as mono or a viral flu but that nonetheless I should get re-tested.  I became sick a few days after I had my blood drawn and have had cold symptions ever since...its been 2 weeks now and I still have a stuffy nose, flem (phlegm), and a caugh.  I am not sure if this can be a due to becoming infected from herpes or if its a cold virus that could have affected my blood work results.  Ive also had mono when I was younger but I dont think this can affect my Igm levels.  My doctor also indicated that had I become infected with herpes, that its a recent exposure (within the past 3 months) becuse Igg levels are negative and that my Igm levels are 2.49.  

I spent the entire weekend freaking out and goodling herpes online.  I called my boyfriend and told him that he could have potentially given me genital herpes and asked if he ever had symptoms.  He said hes been tested,his results came back negative, does not have symptoms, and that I must have cheated on him (which I did not).  We then got into a big fight because I was under the impression that I contracted herpes within 3 months--threrfore he must have given it to me, and we broke up.  I also told my parents that I probably have stds.  

After several hours online googling I realized that there are type specific tests.  I called my doctor today (monday) to ask her if the test I took was type specific and if so what the values are.  She said no, that it was not.  My doctor said she was going to call over to the lab and see if they she can get a copy of the differentials.  However, after googling, I realized that Igm tests are never type specific--so there is no such thing as differentials.  So, this is making me think that my doctor is mis-informed.  I am also really upset that the doctors office did not take the time to explain to me that my test was not type specific and that I could have very well contracted hsv 1 during the initial phone conversation.  They made it seem like I had genital herpes without ever addressing the possibility that it could be hsv1.  Had I known this information, I would not have called my boyfriend and accused him of giving me an std.  I also would not have told my parents I have stds until I had further testing.

My now ex boyfriend has been tested twice for std.  Once in November and once in the beggining of this year.  We have been dating and exclusive since October. However, I have never actually seen his results on paper.  I have never seen any symptoms characteristic of the hsv2 virus on him--but then again he could be asymptomatic.  I trust that he is telling the truth.  However, I know he has hsv1 because years ago I remember he told me he had a cold sore.  

I have never had cold sores or symptoms of genital herpes.  I was wondering if a medical professional can further explain to me the difference between Igg testing and Igm testing.  What are the other viruses that produce Igm antibodies--specifically, what viruses was my doctor refering to when she stated that the Igm results could have been attributed to viruses such as mono...flu...etc?  After researching, I understand that the test I had done has a lot of limitations including false positives.  What are the chances that my test was a false positive and that I do not have hsv2? I want to have another test done, however, I live in Chicago because of law school and my insurance only pays for testing in my home state.  How long do you think that I should wait until I am re-tested.  Also, what test should I have done.  Specifically, I would like to know wheather or not I have hsv2 or hsv1.  How long until I start to build up Igg levels, and will I actually build up Igg levels?  Finally, what are the chances that I have a herpes infection, whether it be hsv1 or hsv2.  If I do have a herpes infection, did I infact contract it within the last 3 months?

Just one quick note:  When I was 16, prior to being sexually active, I had an yeast infection.  I went to my doctor and just out of pure paranoia, got tested for BV, Chlamidia, herpes...etc.  I was naive and did not really fully understand how stds can be transmitted.  My insurance covered all my testing and the office was glad to do it.  I have never had symptoms for herpes, but my test came back positive.  The doctor did not differentiate between HSV 1 or 2.  I requested that the test be re-run, and then it came back negative.  The doctor never explained to me what the discrepency was and simply told me I do not have herpes.  I think its unlikely that I had herpes back then, but can there be something wrong which causes my tests to come back inaccurate?

Any information would be greatly appreciated as I have been a ball of nerves since I got that phone call last friday.  Thanks in advanced!

[gracefromHHP]

the igm is a greatly flawed herpes test. it shouldn't have been drawn on you.  http://www.medhelp.org/posts/STDs/Confusiion-over-other-IgM-Herpes-posts/show/248394  is a terrific prior post that helps explain it more. pretty much completely ignore your igm results.

did you have the igg test done at all?

are you and your ex bf talking about this at all since you've since become more informed?

grace

[TMD123]

Grace,

Thank you for responding to my post.  I did read the post concerning Igm prior to writing this.  It is very informative.  However, I still dont understand what Igm means. The doctor in that post indicated that there are certain people who will test for Igm levels without having exposure to either virus.  From my google search, I understand that Igm antibodies form during initial exposure to herpes or a virus within the herpes family and later Igg antibodies are developed and Igm antibodies disappear.  From what my doctor informed me, I definitely have some sort of infection which I have contracted within the last three months.  It could be hsv 2, hsv 1, mono, flu...etc.  Is this true?  I just need to wait for 3 months so that my Igg levels can develop so that I can be tested accurately for herpes.  The test that she gave me stated that my Igg levels are currently negative, meaning that I do not have past exposure to hsv 1 or hv2.  However, since she claims that mono is in the herpes viral family, wouldnt I have Igg levels that are positive since I have had mono as a child?  I think I am still misunderstanding how this works.

I dont think I have had an Igg test...at least one that was type specific.  I certainly do plan on getting one.  However, again, my doctor indicated that I should wait 3 months so that I can get an accurate reading.  The last time I had intercourse with my partner was 10 days prior to being tested.  Had I contracted herpes during that time, would I have already developed Igg levels that would have shown up in my test?  

I am really dying to get retested as soon as possible.  Since the doctor told me that I could have herpes last friday I have neglected my school work (im in my first year of law school and have 3 weeks until finals so this is really affecting me), I also lost 5lbs in 4 days because Ive been too depressed to eat, and I told my parents that I most likely have stds.  Needless to say, my mom was really upset.  I am willing to take whatever test is most effective and accurate, however, do you think that that I should do this now or wait for Igg levels to develop?  Im going to end up having a test done in chicago because I dont have the patience to wait a month until I go to my homestate and have my doctor do it...so since I have really bad insurance (that i pay for) that covers testing only in my home state, I will be paying out of pocket.  Any suggestions as to what test I should invest my money in?  

And finally, no were not talking.  I think he hates me because he thinks I got gential (genital) herpes from someone else--meaning that I must have cheated since he tested negative.  But like I said before, I have never seen his results on paper, so God only knows wheather or not he is telling the truth.  I like to think that he is, becasue us getting or testing done was his idea.  I am not going to call and talk to him about this until I actually figure out what is going on and I have a paper in my hand indicating to me whether or not I have herpes and if so which type.

In short, the doctor ruined my life...they did not mention the fact that the test was not type specific until I had to call and ask 3 days later.  I really wish I could have been better informed by my doctor before freaking out on my boyfriend and calling my mom crying claiming that I have stds.  I am so glad that forms like this exist and that healthcare professionals take the time out of their day to answer layman questions--its really pathetic that my doctor, whom I know I have paid thousands of dollars to through my insurance, does not feel the need to educate me prior to telling me that I might have herpes.  

thanks again for the response.

[TMD123]

Ok so I did have an Igg which was .40 but its not type specific...sorry i just realized this.

[Mistakeguy789]

Okay lets talk testing for a second while grace is off helping clean out the horse stable.

What is IgM?  IgM testing is as you read a test that is inaccurate for most adults.  This test has a lot of cross reaction but also the chemistry of the test can sometimes become positive without really being positive.  It is a flawed test really and the fact it is flawed hurts the person fearful of such testing.  At this point you need to flat out disregard your IgM test.  The theory as explained by Dr. HHH is that doctors are trained to believe the body will build up IgM anitbodies to fight infections first then once a more accurate antibody can be made (In herpes case gG-1 or gG-2).  However, we have found out that this is not always true. That the body sometimes will develop the gG-1 or gG-2 protein antibodies first as the response to the infection.  Confused yet?  


Think of this in law school terms.  Before you can file a lawsuit you have to have 2 of the most important parts in a filling.  You have to have a claimant and a respondant.  In our world the claimant is the Herpes and the respondant is your immune system response (gG antibodies). (Sorry if this was a failed attempt at humor).  

In the more serious notes if the IgG test wasn't type specific you should have had that one done.  A negative in this one typicall isn't wrong or bad but a positive could have been false as it doesn't seperate the type out.  

Now lets talk IgG testing...  This type of testing checks for the gG protein which is associated with the Herpes infections and doesn't cross react with other virus in the same category on a true type specific test.  Why?  Because its a different antibody altogether.  

If your ex-bf has a negative IgG type specific test and you all were the only two partners each other had for at least 3 months before his test then you can safely assume you don't have herpes.  If he doesn't have it he can't give it to you.  

If you are going to test wait until your 12-16 weeks are up.  No need in testing at this point when you will have to re-test.  Focus on your classes and eat some.  Right now your goal in life is to become an attorney.  You need to focus strongly on this.  Law school doesn't goof around and they don't play.  Given the amount of people that want to be in law school.  Focus on your classes.  I think you will find time flies by faster when you study.  I know this from experince believe me when I say school first.  Herpes won't destory your life unless you let it.  Which you not eating and letting it hurt your studies is letting a micro virus win over you.

[gracefromHHP]

A + herpes igm blood test doesn't mean you HAD to have contracted something recently like mono or something. Your provider's thinking is very flawed with that.  Your igg test was negative. Your partner tested negative for herpes ( and let's assume he had proper testing done ). you have no reason to repeat any of your testing at any point.  

you've paid a hell of a lot  of money to get to 3 weeks from the end of your first year of law school, imagine the malpractice suit you could file in your mind, get good and angry and hit the books so that you can be a successful lawyer in a few years and defend folks who have worse things than this happen to them!!!  use these feelings for good :)

grace

[Mistakeguy789]

I agree with grace VERY VERY MUCH.  :-)

[TMD123]

Thanks for all the advise and reassurance guys.  And yes the plaintiff/defendant analogy was useful and cleverly inserted!  
Yesterday I mentioned that when I talked to my doctor and asked her whether or not my exam was type specific she indicated that it was not but that she would call the laboratory and get back with me.  Supposedly, oftentimes the laboratory has the “differentials” as she stated.  Now let me remind you that my results were a negative Igg of .40 and a positive Igm of 2.49.  So in the midst of all of my doctor’s confusion, she must have actually attempted to get the differentials from the lab for my Igm test because I get a call from her medical assistant today stating that the differentials are not available.  Wow what a surprise there!  Furthermore, my doctor informs me today that I should go to a clinic by my house here in Chicago, have my blood drawn, and then have my blood sent out to her office in my home state so that she can do a type specific test.  Some light bulbs must have finally went off for her.  However, I still think her reasoning is flawed, and please feel free to correct me if I am wrong—but what on earth is she going to run a type specific herpes test on?  I was just tested 3 weeks ago.  I have NO Igg antibodies.  My last possible date of exposure was March 13.  I had all my testing done on March 23.  It has been one month since the date of my last possible exposure.  Could Igg antibodies have already developed?  Also, does anyone know if the type specific tests such as herpeselect also check Igm levels?  
What really shocks me is that my doctor requested that I have this test done, yet is seems like she knows nothing about what the results indicate.  A simple google search told me that Igm is not type specific—so why on earth does someone who has had years of medical school in addition to years of on the job experience as a physician not know this.  Really I just want to call over there and be completely nasty to them and say, listen, if you cant even read the test results DO NOT administer them to me!  The name of the game is not lets see how many tests we can perform that the insurance company will pay for—its correctly diagnose me!  I know I sound bitter, but I am.  
If I can give anyone in my situation a word of advice, its to do your research before you talk to a health care professional regarding your situation because believe me, many of them do not know diddly squat and just depend on the fact that you are a layman when they talk to you so they are able to cover up their ignorance.  In my profession, we call this negligence.  I am not yet a lawyer, nor would I be able to defend you in ANY legal situation, but I’m sure that if I lapsed into legalese when talking to you, threw in a few legal concepts, maybe an affirmative defense here and there, cited a statute (any statute, not like you would know the difference) I could convince you of my so called competency—What I am trying to get is that most of us are laymen who know nothing about the medical field—we rely on our doctors to inform us…they know this and they use it to their advantage.  They talk to you like they have all the answers and know exactly whats going on, but in reality they don’t…so be proactive and scrutinize everything that they say to make sure you really are getting sound medical advice.
Finally, regardless of my results, I feel like this experience has been emotionally devastating.  My boyfriend literally abandoned me.  Part of this I blame on myself because I approached the whole situation terribly and made it sound like he gave me an std.  Part of this I blame on the doctor who had failed to adequately inform me regarding my situation for three whole days.  Literally, all I got was a “you might have herpes” until I called in the following Monday with a stack of questions.  But what hurst the most is that the person who had I contracted the disease, would have been the one that gave it to me, completely refuses to talk to me.  His response was “its your problem, I tested negative twice for everything—deal with it.”  I know having herpes is not the end of the world, but when being confronted with the situation and having a million questions that you want answered, its really important to have the support of your loved ones at your side.  Instead, the one person whom I thought I could trust completely turned his back on me.  Again, dealing with me was no walk in the park, but come on.  Even if this whole thing resolves itself and it turns out to be hsv 1 or nothing at all—I will never be able to get over the way he acted.  What is even worse is that I am hundreds of miles away from my family because Im stuck in school, I feel like I have no one that I can talk to regarding my situation…I don’t want to discuss this with my friends from school because I know that they wont understand and also I know that there is still a bad stigma associated with any type of std—even if its just a harmless skin virus.  So, in short, I feel completely alone.  Im really grateful that cites like this exist where people turn for advice and openly discuss their problems without being judged.  Thanks for all your support :)

[gracefromHHP]

As I already said, you actually have no reason for any retesting. If you need peace of mind, wait until you are home to get the type specific test done just for your own records.  If he's testing negative, it wasn't a newly acquired infection for you.

in your doctor's defense, for most infections, the igm is a fairly accurate way to diagnose a newly acquired infection.  there are type specific herpes igm tests out there but even they still have a low accuracy rate for the most part.  Unless you are a newborn or involved in a research study, waiting and getting the igg testing is in your best interest.

If you are feeling generous, for $3 you can purchase the herpes blood testing toolkit from ashastd.org to give to your provider when you get home. tell them merry christmas early :)  http://www.ashastdwebstore.org/herpes-testing-toolkit.html   Perhaps just handing it to your provider would keep you from telling them what you really think about the situation!!!   Of course a post it note saying "so you don't put other patients through what I've been through needlessly" would go well with it :)  It does appear that your provider is open to updating their information which is a good thing!  

I'm glad you found us for answers too :)

grace