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Negative IgM Results - Potential Exposure to HSV
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Negative IgM Results - Potential Exposure to HSV

I'm a 38 yr old man.  I had unprotected sex with two different women.  The second woman recently had a positive HSV culture from a small lesion on her labia.  I requested a full STD screening, as well as test for HSV.  At the time of the tests, it had been 9 and 7 weeks since my encounters with the two women.  All STD results were negative, including a negative IgM.  I've never had, nor currently have any symptoms or indications of the virus.  

The doctor insisted that I'm fine, to accept the result, be more responsible and move on.  Another doctor explained that I am now simply part of a very large population that are, or may be infected, but not aware, nor will likely ever know or have reason to believe they are, and better off not knowing, since the detrimental social and pyschological affects greatly outweigh the alternative.

I questioned both doctors about an IgG test.  Both felt it was not necessary, but if I insisted, would order the test.

I am incredibly stressed about this and have not slept well in weeks.  The negative IgM result was a huge relief.  However, as I understand, may only be encouraging news, and not accurate.  I am terrified to return and do yet another test (IgG), and wait for the results.

I've heard and read so many different bits of advice from people in, or associated with, the medical field about how common HSV is (prevalence of un-diagnosed, asymptomatic carriers), the social and psychological affects of knowing, why its not part of standard screenings, your better off not knowing, etc...  I'm not sure what to do at this point.  And frankly am very scared.

Do I go ahead with an IgG test?  Are the potential social and psychological affects worth having?
55646_tn?1263664409
Are you saying that the only herpes testing that you've had for herpes so far is an IgM test?  If that is true, then you haven't been tested for herpes.  The IgM is NOT a reliable test for diagnosing herpes.  

As for the pros and cons of being tested:  Here is my opinion.  If you have an infection that can be given to other people, even if you have no symptoms, that can be treated with good safe medicine, I think should know about it.  The thing about it is, this isn't just about you anymore, if you happen to be infected.  There is nothing medically scary that we know about herpes at this time.  It is an annoyance and is stigmatized.  

Please remember that what is, is.  Testing will only identify what is.  

Is there any suggestion from the woman who tested swab test positive that you gave herpes to her?

Terri
30 Comments
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Avatar_m_tn
Terri -

Yes, that is correct.  I've only been tested for IgM.

As for the girl;  Her previous boyfriend insisted that she be tested for Herpes before they had sex.  I don't know what type of test she had, but she says it was negative. Her test was over 1 year ago.  She said she has not been with anyone else since.  A few weeks after sex with me, she noticed a small lesion, that was irritated when she urinated.  A culture of the lesion was positive for Herpes.  Her blood test was again negative, however, I don't know what type of blood test was done.  She concluded that she must have been infected by me.  

Is it possible that both blood tests she had were also IgM only, and she may have already had it?  Are false positive swabs common?
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55646_tn?1263664409
Let me be certain I have all of this clear.  Your partner tested negative for HSV a year ago (we don't know what kind of test) and has had no other partners since.  And now she is culture positive.  

I would suggest that she get a copy of her results.  If they are IgG tests, then it sounds most likely that she got herpes from you.  If she was truly negative by IgG, truly has had no other partners since that test and truly has a culture positive lesion, I don't honestly see another way for her to have gotten this except from you.  And we don't know your herpes status, right?

Terri
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Avatar_m_tn
That's correct.

Again this is assuming that she has been truthful with me about her sexual history and her previous tests were IgG negative.  Both of which I don't really know.

Frankly, I'm afraid of knowing I have it (assuming I do).  Had I not met and slept with this woman, I would not be having this conversation, or worrying about it.

That being said, what I don't understand is, why HSV is not part of standard STD screenings, nor is it even mentioned when a full STD screening is requested?   If so many have it, and don't know they have it, and are spreading it, why is it not screened?

If my IgG tests are positive. How far back do I go and tell women that I've been with, that they may be infected as well?

It almost appears to opens such a "can of worms" that unless you have symptoms or a very good reason to believe you may have it, its better left alone..???
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Avatar_m_tn
One other clarification:   She continued to be sexually active with her boyfriend after her HSV test, well over a year ago.  Even after their relationship had ended, I understood that they still had some periodic sexual contact.  
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Avatar_m_tn
One other clarification:   She continued to be sexually active with her boyfriend after her HSV test, well over a year ago.  Even after their relationship had ended, I understood that they still had some periodic sexual contact.  
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55646_tn?1263664409
I think that HSV testing should be included in any STD screen. Period.
I think that not everyone includes it for the very reason you mention - they don't want to open the "can of worms".  However, in my mind, if you are asking for an STD screen, you are asking for the can to be opened, right?
The reason you should know is that if you have herpes, you can infect people, even if you have no symptoms.  Which may have already happened.  Does that make sense?

Terri
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Avatar_m_tn
Thanks Terri.  I think I will stop by the lab in the morning and go ahead with the IgG.

All of these years I've been getting STD screenings, and I had no idea that Herpes was never a part of them.  I was simply always told that all tests were negative, and all my other numbers (PSA, cholestorol, etc..) were great.
In the end, I just feel horrible and disgusted that I was so ignorant and uneducated about this.

That being said... I have a few more questions, if I may:

1.)  If IgG is positive, what is the recommended dosage for suppressive medication for someone that is asymptomatic?  I would only be controlling the amount and frequency of shedding, correct?

2.)  If IgG positive, is there anything in the results that indicate how long I've had it?

3.)  If IgG positive, and medication is prescribed, do I need to take it always?   Or only when I anticipate being sexually active/ intimate again?

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Avatar_m_tn
Thanks Terri.  I think I will stop by the lab in the morning and go ahead with the IgG.

All of these years I've been getting STD screenings, and I had no idea that Herpes was never a part of them.  I was simply always told that all tests were negative, and all my other numbers (PSA, cholestorol, etc..) were great.
In the end, I just feel horrible and disgusted that I was so ignorant and uneducated about this.

That being said... I have a few more questions, if I may:

1.)  If IgG is positive, what is the recommended dosage for suppressive medication for someone that is asymptomatic?  I would only be controlling the amount and frequency of shedding, correct?

2.)  If IgG positive, is there anything in the results that indicate how long I've had it?

3.)  If IgG positive, and medication is prescribed, do I need to take it always?   Or only when I anticipate being sexually active/ intimate again?

I'm sure the doctor will have his suggestions on this, but given the fact that I had to explain to him why I needed to be tested for IgG in the first place, it  wouldn't hurt to have a second opinion on the treatment.

Thanks,
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55646_tn?1263664409
1.  The dose for suppression is 400 mg of acyclovir twice a day or 500 mg of valacyclovir twice a day.
2.  No
3.  People go on suppression for one of two reasons:  to suppress the frequency of recurrences or to help protect a sex partner.  If neither of these are happening, you don't need to take it.  but if you do take it for protection of a partner, know that you need to take it for five days before it is fully effective.

I think your doctor could use a good continuing education program about herpes.

Terri
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Avatar_m_tn
Thanks Terri.   I should have my results for the IgG later this week.  

Do you have some good suggestions for resources to help deal with herpes?  

Also, I'm curious what your thoughts are on Genocea and HerpV.  

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55646_tn?1263664409
We are doing the trials of both HerpV and Genocea.  No data yet.
ASHASTD.org has good info as well as our website, westoverheights.com has the Herpes Handbook you can download for free.

Terri
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Avatar_m_tn
Thanks Terri,

My IgG results came back today as the following:

Herpes Simplex 1 IgG   >8.0
Herpes Simplex 2 IgG   < 0.2

I want to be sure I am reading these correctly.  Could you please confirm?

Thanks,
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55646_tn?1263664409
These results indicate that you have HSV 1 infection and don't have HSV 2 infection.  

Have you ever in your life had a cold sore on your lip or in your nose?  If yes, then that's where the HSV 1 antibody is coming from.  If not, then we don't know where you have HSV 1 infection, but you do have it.  

Without knowing something about the type of herpes the woman you describe has, I'm not sure what to make of this.  Also hard to know if  she was actually tested for HSV 1 ever.  

Terri
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Avatar_m_tn
Terri,

I've never had a cold sore, anywhere.  Or at least, that I was aware of.  I get canker sores sometimes on the inside of my mouth, gums and lip.  On occasion I get a small sore in the corner/crease of my mouth/lip, but as far as I can remember I only got them when I was somewhere with a dry climate and it cracks, or I scratch it with my razor when shaving. And its definitely not something that randomly or periodically appears for no apparent reason.

As for the woman I was with, I still don't know what type of tests she had previously (over 1 yr. ago), or what type she had most recently (9 wks ago).
I plan to ask that she find out.  

Questions:

1.)  Does a Type-1 infection provide any level of resistance to a Type-2 infection?

2.)   I get "jock itch" sometimes, in the crease between my thigh and my scrotum.  Could that possibly be mistaken for a Type-1 outbreak? Its red, itchy and irritated, but very mildly, and usually only lasts a few days, if I let it dry out and don't scratch.

3.)  I plan to continue seeing this woman.  We've limited our physical relationship significantly until we are both fully aware of our individual status.  Now, that being said, she having Type-2, me having Type-1,..(sorry if these are odd questions):
       a.  Is being naked together in the shower and fooling around (no
            vaginal penetration) safe, without using a condom?
       b.  For sex, she would need to be taking a suppression med,  
            and I would need to always wear a condom, in order to be the
            "most safe" against transmission of Type-2 from her to me,
            correct?
       c.  Does there need to be a genital fluid exchange for transmission to
            occur?  (typically)
       d.  Assume the relationship progresses to marriage and we want to
            have children, what is the safest way to conceive without risking
            transmission of Type-2 from her to me?
       e.  I have Type-1, but since I don't know where it is coming from, how
           do I not transmit it to her?   Is asymptomatic Type-1 common?
           How do you go about finding out where it is coming from?


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Avatar_m_tn
... also, I found out yesterday that she had never been tested for Type-1 or Type-2.  (I understood that she and her partner had a negative HSV test over 1 yr. ago, and that she had not been with anyone else since).  

I also found out, that after we had sex, she had an outbreak within a couple of days.

Her subsequent culture was positive for Type-2, and a negative blood test (she still does not know what type of test was done).  I suggested she find out what type of blood test was done, from her doctor, but she was very upset after I explained my test results were negative.  She refused to talk further about it and hung up the phone.  This is heartbreaking for me, and I can't imagine what she is going through as well (long distance relationship, unfortunately).

For my most recent exposures the two women (two weeks apart):
IgM negative at 9 & 7 weeks exposure
IgG negative Type-2 & Positive Type-1 at 10 & 13 weeks exposure

Given the new information, it seems she already had it, and the vigorous sex (she is also very small, and I'm rather large), may have triggered a response?   Or is it possible that my body produces antibodies so slowly that I have a false negative IgG and IgM result?





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Avatar_m_tn
Hi Terri,

I apologize for so much information & questions in the previous few posts, but here is the latest and (not so) greatest:

Me:
IgM - Negative for HSV
IgG - Positive Type-1,  Negative Type-2

Her:
IgG - Negative Type-1,  Negative Type-2
Culture/Swab - Negative Type-1,  Positive Type-2

I've never had a cold sore in my life, anywhere.  No idea where the infection is.

My most recent potential exposure was 13 weeks prior to my IgG test.  And about 10 weeks since exposure to the woman in question.

Other than me, she has not been with anyone else sexually for at least 3 months prior to her IgG and Culture/ Swab.  (I'm assuming that is truthful).  This is why she was so certain that she got Type-2 from me.  But my Type-2 IgG is negative as well as IgM.

What do you make of this?

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55646_tn?1263664409
I'm a little confused.  
Who did you have sex with first - the one who tested positive for herpes or the other one?  

Terri
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Avatar_m_tn
The other one.  We had sex 13 weeks prior to my IgG.

The second one was who had an outbreak within a couple of days after we had sex and tested for the results above.  I was with her 10 weeks prior to my IgG.  I don't know what her sexual history is longer than 3 months prior to her IgG.

I read that IgG can take from 3 - 6 months to turn positive.  6 months?

I'm afraid I may have gotten it from the first girl, and unknowingly passed it to the second.  If it does take up to 6 months to turn positive, then there's a chance I may have gotten it from an ex-girlfriend.  We had sex within 6 months of my IgG.


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Avatar_m_tn
Also - Just FYI
This is ver-batum how my results were posted on my online medical profile by the clinic/lab:

HERPES SIMPLEX TYPE 1 & 2 AB, IGG

Component                 Your Value      Standard Range   Units
Herpes Simplex 1, IgG >8.0                                    AI
Herpes Simplex 2, IgG <0.2                                    AI

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55646_tn?1263664409
Yes, I'm concerned that you may have acquired it from the first woman and gave it to the second woman also.  It is a long time for no antibody response, but you do have a strong HSV 1 result and it can take longer for seroconversion when you have HSV 1 and acquire HSV 2.  I don't recall - have you taken any antiherpes medicine?  That would also slow seroconversion.  

If I had to guess, and this is a guess, the above happened.  

Terri
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Avatar_m_tn
No, I've never taken medication.  I just found out my IgG results last week.
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55646_tn?1263664409
I guess I would recommend that you get retested in a couple of months.  I'm really not sure what happened here.

Terri
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Avatar_m_tn
You can get tested again in a few months and it will show negative. these tests are not reliable. western medicine (no offense Terri) does not have a good understanding of these "viruses".

you will find plenty of people who tested positive at one time and then negative at another time. this is impossible according to western medicine because the virus stays for life.

its just not true. i have been exposed to women with std's many times and i have tested negative. testing positive is based on your mindset at the time. the test is only for antibodies anyway...if you dont have symptoms then why say you have a virus? doesnt make sense.
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Avatar_m_tn
Terri,

I've tried finding information on how long it typically takes for blood to turn positive IgG for Type-2.   Many sources say that after exposure and acquisition, 50%, or most, will show positive IgG by 1 month, about 75% - 85% by 2 months, and all or nearly all will show by 3 months.  A few say it can take up to 6 months.  So which is it?  

And yes, I believe a retest in a few months is the only way I will really know for certain what happened.  
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Avatar_m_tn
Concernedguy23

I appreciate your input here.  I am more concerned with being an asymptomatic carrier of the virus, and passing it on to others.  

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55646_tn?1263664409
For both of you:  It is possible to have a positive ELISA followed by a negative ELISA, yes.  That is almost always true when the ELISA is in the low positive range and was never truly positive.  That is why we recommend confirming all low positives.  If you look at the research, you will find that while this can happen with ELISAs it does not happen with western blot testing.  

Yes, by 3 weeks about 50% of people will become positive (of those who will all test positive), by 6 weeks, 70% and by 4 months, most everyone.  There are a few people will will become positive after that, but honestly, we rarely see that in our practice.  That most often happens when the person in question has taken antiviral therapy.

Hope this is helpful.

PLEASE, readers, be careful what information you take to heart.  

To Concerned guy:  

People test for herpes by antibody because they can give virus off from their body even if they never have a symptom, ever.  A positive antibody test means they are infected with the virus and can infect others.

Terri
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Avatar_m_tn
Terri,

I understand that the information you have shared with us is the information about herpes that is widely-accepted today among the medical field.

Diagnosing somebody as HSV-1 or HSV-2 postive (which means they "have herpes") is based on the assumption that finding 'antibodies' to an hsv virus in blood, and assuming that the hsv virus never leaves the body.

What proof is there that there are 2 specific types of "herpes" viruses, and then never leave the body?  

Under a microscope, the HSV-1 or HSV-2 virus looks almost identical to an influenza virus. Why would this specific type of virus simply not leave the body?  
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Avatar_m_tn
Terri,

By low positive do you mean between 0.9 and 1.1?  Or between 1.1 and 3.5?  I've read that either one and/or both are considered "low positives".   Mine was <0.2, so is that considered a low negative or a low positive?
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55646_tn?1263664409
Your test is a firm negative.
We define low positive as 1.1 to 3.5, that is correct

Terri
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Terri Warren, RN, Adult Nurse Pr...Blank
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