Can I really disregard the IgM information?

[confusedandsad]

Thank you so much for offering this service. Background: I've been having sex with another woman for two years. We're technically not exclusive, but during that time she's never been with anyone else. In August 2004, we both tested negative for HSV 1 & 2 (by HerpesSelect) after I freaked out about a single, hard bump in my pubic hair. The bump went away in 4 days or so without scabbing. In August 2005, I made out with a stripper at a bachelorette party for 10 minutes. A week later, my gums were kind of swollen and irritated. I was concerned, but didn't get tested for anything. In October 2005, I had a fling with another woman (gave her unprotected oral sex). About six weeks later, SHE had a bump somewhere on her vagina, which her dr. said wasn't herpes (called it a "normal vaginal ulcer"(?)). Her herpes bloodwork was negative.

Fast forward to now. The woman I've been steadily sleeping with got the first cold sore of her life six days after I last had unprotected oral sex with her. She thinks she got it from working with kids. I flipped out! We both got tested for herpes at a clinic that does HerpesSelect and an IgM test at the same time. Our results came back the same: the IgG was negative for HSV-2, positive for IgG HSV-1, and positive by IgM for an unspecified type. The clinic reported these as "negative for an old HSV-2 infection, positive for an old HSV-1 infection and positive for a new infection of indeterminate type." Because we were positive for an old HSV-1 infection, the clinic concluded that the new infection was more likely to be HSV-2!! They told us to wait six months, then retest for HSV-2 to be sure.

I called the National Herpes Hotline to see if that made sense, and they basically agreed, but said we could retest in three months. I told them what I'd read here about IgM being meaningless, and they said that was wishful thinking ("You're hearing what you want to hear.") Based on all of this, here are my questions:
1. Can I really disregard the IgM results? Why would I have a positive IgM if I don't have recognizable symptoms (I thought positive IgMs were for recurrent outbreaks- to my knowledge, I haven't had one yet)? Why do the clinic and hotline think the IgM is a new infection?
2. I've never recognized any herpes symptoms, but started to feel vaginal burning within hours of hearing about her cold sore. The burning has persisted for days, but no sores. The dr. examined me for lesions twice and saw none, but diagnosed a stress-induced yeast infection. Could the burning and irritation without sores be genital herpes?
3. The stripper was 7 months ago and the other woman (who tested negative for herpes) was almost 5 months ago. If I contracted HSV-2 from either of them, wouldn't it have shown up on the HerpesSelect test by now?
4. If she hasn't been with anyone but me for 2 yrs, and my last exposure to anyone but her was 5 months ago, do you see any "new" HSV-2 exposure? Could she get HSV-2 from working with kids?
THANKS!

[H. Hunter Handsfield, M.D.]

I stand by the information you will find on this forum about HSV IgM antibody testing; search for "IgM" and "herpes diagnosis".  I am unaware of a "National Herpes Hotline".  If you are referring to CDC's national STD hotline, the people on the phone are not trained health educators and "know" only what they are trained to say, with little ability to answer complex questions in context.  (A shame; the hotline used to be run by a contract from CDC to the American Social Health Association, which provided much better service.)  The only other herpes phone line that I know about is ASHA's own service, which is not toll-free.  I would be surprised if they believe HSV IgM testing has value--in which case let me know and I will contact my colleagues there.

1) Having said how unreliable IgM testing is, the results are not always wrong.  If you are sure your most recent IgG test was a type-specific one, such as HerpeSelect, you can be confident you do not have HSV-2.  But if there is any uncertainty as to when you could have last been exposed, you might want to have yet another test at least 3 months after the last possible time when you could have acquired a new infection.  

2) Herpes and yeast can cause similar symptoms, but if your provider was confident you had yeast, that should be pretty reliable.  Stress does not induce yeast infections, though.

3) Yes, if you acquired HSV-2 5-7 months ago, your test should have been positive.

4) For HSV-2, there are virtually no exceptions to sexual transmission (unlike HSV-1).

Good luck---- HHH, MD

[t1234]

From personal experience I can tell you that IGM results
are meaningless.  I had the same experience you have with labs
on three ocassions until I got tired of paying for repeat
tests months later only to find out I was IGG negative for HSV2.

In-so-far as herpes is concerned, in my opinion, this is just
a way of selling repeat testing.  Most scared and anxious
people will come back in a few weeks to get retested, then
again in three months.  In fact you could end up in an endless
cycle of retesting with repeated IGG HSV2 negative and IGM positive at a cost of thousands of dollars.

When I hear these stories, I'm reminded of the the "imortal words" of Warner Brothers Cartoon Character Daffy Duck.
"It's too late for a Doctor, call my Lawyer!"

[xtra]

The IgM test can not differentiate between hsv1 and hsv2.  So what ever it's positive for, you still don't know which type, let alone you even have herpes. Check out this message from about a week ago.
http://www.medhelp.org/forums/STD/messages/2548.html

The old thought process was an IgM positive result meant a recent infection.  However, studies have shown the IgM antibodies show up for recurring outbreaks about 33% of the time, so you won't know for sure if it's a new or recurring infection.

I'll take the opinion of Dr H and Terri Warren over someone answering a hot-line phone on the subject of Herpes. :)

[confusedandsad]

Thanks very much for the comments. I agree with you that Dr. HHH and Terri Warren are better experts than a hotline, but based on the second response I think my description may have been unclear. If the HerpeSelect test is accurate, I do know that I have herpes, since we both tested positive for HSV-1 (but negative for HSV-2). Also, she had a classic cold sore, so we knew even before testing that she at least (and probably at most) picked up oral HSV-1 somehow. What we don't know is whether the HSV-1 I have is oral or genital or both. I'm trying not to spin out about that.

But the true concern that's causing me to lose sleep is totally separate: it's that the clinic and the hotline both said that our positive IgM is likely to be a "new" HSV-2 infection, since we both already have an "old" HSV-1 infection. As I noted before, she hasn't been with anyone but me for more than 2 years (which I truly believe), I kissed a stripper 7 months ago and I performed unprotected oral sex on another woman 5 months ago. I've had tons of unprotected oral sex with the first woman since then, because until her cold sore cropped up, we'd both always tested negative for everything. So one of the mysteries is where the HSV-1 came from-- one of my two encounters (most likely the stripper, since the other girl tested negative for both kinds of herpes) or the kids she works with all day. But the real concern is whether the positive IgM really is more likely to be HSV-2 because we both already have HSV-1. Of course, we've been constantly exposed to each other, but the last external exposures were 7 and 5 months ago, so how could the positive IgM be a "new" HSV-2 infection that wasn't picked up on the HerpeSelect IgG?  Wouldn't herpes from an exposure 5 months ago show up on the IgG? And why would I have a positive IgM result if I haven't had any new exposures and don't have an discernable active/recurrent outbreak? The clinic suggested that she may have picked up an HSV-2 infection from one of the kids she works with, but that just seems nuts.  It's all SO confusing!

Please let me again say thank you for the comments and thanks in advance to Dr. HHH. This forum is an incredible gift!

[confusedandsad]

Dr. HHH,

Shoot- I was writing a clarifying addendum to a comment I received (thanks very much to everyone who replied) when your answer was being posted, so my second comment probably didn't make very much sense.  Thank you so much for your response!

You are right: the hotline I called wasn't toll free, it was a (919) number.  I just called it again to check who it was, and the introduction is "Thank you for calling the national herpes hotline, a service of the American Social Health Association."  The woman who answered yesterday initially said that Igm is meaningless, but after I explained the clinic's reasoning to her (that the positive IgM was more likely to be HSV-2 because I already have HSV-1 and don't have an active or recuurent outbreak to explain the IgM), she agreed with them and said it was more likely, to be HSV-2, but not necessarily.  She also was the person who said that I was "hearing what I wanted to hear" because I don't want to accept the reality of possible HSV-2.  She thought the clinic's idea about HSV-2 from working with kids was unlikely but possible if the kid was born with it.  At that point, the entire world started to seem radioactive and I got off the phone.

I guess my real question may be unanswerable:  if neither she nor I have been with anyone else in the past 5 months, and we both tested negative for HSV-2 by HerpeSelect, then can we relax about HSV-2 despite the positive IgM results?  I know we're exposed to each other every time we have sex, but if she hasn't had any other sex partners for two years, and my other sex partners were 5 and 7 months ago, then what IgG result (and in response to what exposure) are we waiting for?  I don't want to be unduly optimistic, but it just seems like there's little chance that we're passing anything else between us, since it's been 5 months since either of us had any sexual contact with anyone else.  Is there a clear answer here?

Thanks a million.

[xtra]

Usually an IgM test just muddies everything up, which is why everyone says to disregard them.  You'll find many doctors and clinics are not up to speed with proper herpes testing.  The clinic is making an assumption that a positive IgM with an existing positive hsv1 means you've having a new hsv2 infection.  That assumption is flawed, or at least not a guarantee, because the IgM antibody is known for showing up in recurring outbreaks.

Re-reading your post, it appears all your exposure is female to female.  I thought I read somewhere (but don't quote me) that this scenario produces more genital hsv1 than hsv2 because more oral sex is occurring; not sure if there are any studies on this, but I thought Terri mention this on WebMD.  That being said, what you have going on could be an hsv1 genital infection.  The problem with that thought is already having the hsv1 antibodies usually prevents the same type infection in the other location.  Keyword= usually.

A blood test can only tell you what you have, not where you have it.  If you or your partner has a visible genital outbreak, have it cultured and type within the first 48 hours.

Maybe the Dr will correct me on anything or add more information.