A few questions about recent literature

[sortingthingsout]

I was contacted about a week ago by a friend with whom I had two encounters with, once in late February and again in late March.  We had unprotected genital contact but no penetration, and also oral sex.  We are both 23.  She had had a broad STI screening as part of a physical, and her IGM screening came back barely positive by EIA (negative by titer) and the IGG came back negative for one strain and equivocal for the other (no symptoms at all).  Her CNW said that those results may have indicated either a new or recurrent infection, and she is now having a second type of test. I became immediately worried, because I had had unprotected sex with another woman in December.  In early February, I was biking and got what I thought was a friction blister on my penis- it only lasted a few days, and I had no other symptoms with it.  I have never had any other herpes-like symptoms, either orally or genitally.  I had not been tested for STIs when she called, so went to the university clinic, where the doctor told me that I probably had nothing to worry about, but that he would order an IGG test because I was worried- otherwise, he probably wouldn't order it, due to the high rate of false positives.  I’m waiting on results.
Intrigued, I found this and other sites, then went to the primary literature. I came up with a few questions.
1) I realize the IGM is error-prone (Morrow and Brown 2005 Am J Obst. and Gyn. 193: 361–2), but Morrow et al 2006 (Clin Microbiol Infect 12: 463–469) does say that an IGM test can be useful in the detection of early seroconversion.  What do you think that the chances of seroconversion are for my friend?  
2) Considering the results of Mark et al 2007 (Sex Transm Dis, Vol. 34, No. 3) and the citations therein(esp. Golden et al 2005), what would you consider to be an unequivocal positive herpeselect IGG value for a low-risk individual?
3)What brands of IGG tests do you consider reliable?  Are positive values different for different tests?
Thanks!

[H. Hunter Handsfield, M.D.]

Directly to your questions.

1) IgM antibody testing to herpes is not just error-prone.  It is meaningless.  Your partner's negative IgG result shows she doesn't have HSV.  (In 30+ years in my STD clinic, we have never once requested an IgM HSV test.) So all the rest of your questions and concerns are irrelevant.  Use the search button on this forum to look for threads on 'herpes diagnosis' and 'IgM'. You can expect her follow-up test to be negative.

2) I'm not familar with the papers you cite except Golden et al, on which I am a co-author.  In a person at low risk, a HerpeSelect ELISA ratio of 3.5 or greater is unequivocal evidence of HSV-2.

3) HerpeSelect (Focus), Trinity Biotech, Kalon, and BiokitUSA all are reliable. The last has no numerical value to it, just positive/negative.  I don't know the numerical range for the others except Focus.

Congratulations-- herpes isn't an issue for you.

HHH, MD

[gracefromHHP]

I'm pretty sure I read the morrow article and I believe that was with a new igm test that they were testing - not the most commonly available ones ( too lazy to go look it up to read it again ).  I'm still not sure it holds much benefit outside of research though for routine diagnosis of herpes.  I'm sure HHH will agree.

grace