General Herpes Testing Question and Case Specific Question

[howthehell]

Your views on IgM herpes blood testing are quit clearly negative. My general question is how can such a widespread and established test have absolutely no value? The non-type specific results and occasional failure of detectable IgM to devlop are obvious problems but when taken into account it would seem that useful information, although not definitive, can still be gained. If one knows they already have oral Herpes 1 (who doesn't?) and can pin point the exact moment of potential exposure a negative IgM would seem to offer some measure of comfort to a person fearing recent infection. As the IgM test, baring overt physical symptoms, it the only measure that could provide some incite into the liklihood of a recent infection. Incite which could alleviate some anxiety stemmming from the exprience.  Or am I wrong?

Now how this applies to my case. 17 days ago I made the unwise decision to recieve oral sex, with a condom, from a woman of very questionable morals. 2-3 days after the fact I experienced significant tingling/itching in the gential area.  4-5 days later  in the mornings I experienced very minimal penal discharge, very clear and more viscous than I have experienced before. Visited two different doctors in this time. On the 6 day a IgM and IgG test was performed (EIA in Europe). Both came back negative. Days 9-10 experienced fairly significant pain in the pelvic area, above the penis and to the sides. Often felt the urge to pee as any accumulation of urine made the pain more severe, this also included the need to defecate. This passed. Day 14 the clear discharge reappeared for 10 minutes in the evening and in much greater quantities than before. Other phyisical signs out of the ordinary have included when the blood was drawn a signicant bruise developed. I have often given blood and plasma and never experienced such a bruise. My eyes have been very itchy. Had them examined and was told only that they were dry. Also, a first. The consistency of my ejaculate has also changed to be more fluid like and when I have masterbated there as been no pre-***, also not normal.  I have experienced cold sores before but not in the last 1.5 years but currently feel one forming.  My sleep has been compromised which segways to..

As you may have gleaned I have been quit obsessive about this.  I am in long term relationship but doing long distance at the moment and the guilt has been significant. I have already told my girlfriend but still feel that guilt may color my perception. The internet is very dangerous thing to person dealing with such emotions and the knowledge that I have gained may have been affecting my evaluation of the situation.

I met with my doctor on the 17th day and he assured me that there was no reason that I should abstain from sex when I reunite with my girlfriend in the near future. Would you agree with this or should I wait for the test results at the 3-4 month mark which I will certainly do? Can I take some comfort from the IgM test?

[H. Hunter Handsfield, M.D.]

First, I endorse most of the comments (below) that preceded my response; your risk of getting herpes is low.  Also, the problem with negative IgM tests is that they are often falsely positive--i.e., an abnormal result in someone without HSV infection at all, or with chronic and not recent infection.  When the IgM result is negative, especially in someone who believes s/he was exposed recently, it usually is a reliable result; so to answer your very last question, yes, you can "take some comfort" from your IgM result.

Second, your symptoms do not suggest herpes. Had you come to my clinic, I would not have recommended HSV testing unless you had more typical symptoms than you describe.

As to why IgM testing is so widespread despite being so unreliable, the reasons are complex.  Before truly type-specific tests became generally available, which has happened only in the past 2-3 years, all HSV testing was highly unreliable.  In the face of unreliable, difficult-to-interpret results, providers and laboratories tried to use all available technologies.  For the past 40 years, it was thought that IgM HSV testing helped to detecte early infection.  For most infections, IgM antibody does develop before IgG antibody, and it was thought to do so for HSV as well.  But it just isn't true for HSV; IgM often does not precede IgG, and IgM often persists or reappears in people with chronic infection.

Nonetheless, over the decades, labs got used to doing the test and providers got used to seeing the results, and some labs have continued to offer routine IgM testing even though positive results almost always are unreliable.  There also is a strong economic incentive for labs to continue to offer the test:  it is dirt-cheap to do, but reimbursement is high; the profit margin for IgM testing is enormous, and much greater than that for the type-specific HSV IgG tests.  Bottom line:  old habits die hard, especially when there is a buck to be made.

Good luck--  HHH, MD

[moet]

Oral sex WITH a condom...sure Dr. will say no risk at all.

IgG is the way to go at 6 weeks and then 12 to be 100%. IgM takes other viruses into consideration like previous exposures to chicken pox and I think shingles etc...So the Dr. recommends not even bothering to order that test, especially when IgG will give you everything you need.

Hey, understand the guilt but you are in a better position then most...so go back to enjoying life ;)

[monkeyflower]

I agree with moet. You're not at risk of herpes, that's for sure, because not only is oral a remarkably low risk activity in general, but you had oral with a condom - AND you already *have* HSV1, the herpes virus that can be transmitted via receptive oral. So no worries about that.

I think all of your symptoms can be explained away one by one and are not at all related to this incident. For instance, dry itchy eyes just happen sometimes. Bruising after having blood drawn just happens sometimes (applying pressure after withdrawing the needle helps). These things aren't symptoms of herpes, anyway. Anxiety is almost surely magnifying anything you're experiencing :-)

[gracefromHHP]

If your IGM is negative it might provide you with a reason to wipe the sweat off your brow and go "phew!!! ". If it's positive it's of little to no use since it isn't an accurate indicator of a recent infection with the virus, isn't type specific and can be present due to other viral illnesses, both past and present. If you plan on repeating any blood tests in a couple of months for herpes make sure it's only the igg test and is type specific.

That all said your symptoms don't sound like genital herpes.  Discharge as you've mentioned doesn't often occur with herpes infections. Were you also tested for other std's?  Were you treated with any antibiotics or oral antifungals at all?  Did a doctor mention prostatitis to you at all?

If I was your gal I wouldn't want to be intimate with you until this discharge issue was all cleared up.  You don't have to mention the oral sex encounter but it would be nice to tell her you are having discharge and need to get it cleared up before having sex again.  I'm sure you wouldn't want to have sex with her if she had bv or a vaginal yeast infection so same goes when the shoe is on the other foot :)

grace

[matthew78]

Your situation seems to resemble mine at the moment. When you are in a long-term relationship and have done something you really regret, it is hard to let go of the bad thoughts.

My case: I cheated on my girlfriend (6 year long relationship)for the first time 16 days ago as I received protected oral sex from a prostitute. After four days the tip of the penis started to burn mildly, and I also felt a stinging sensation "moving around" in the urethrea. It is now better, but the glanse still feels a bit "cold" and burns very mildly. Tests for gonorea and chlamydia were negative. Like you, I have been losing sleep and experienced severe anxiety, both for cheating on my girlfriend and for having caught an STD.

The doc knows best, but I believe that most likely your and my symptoms are caused from stress/anxiety. If there were an STD that could have caused the symptoms, I would guess it was an unspecified urethritis. As I have been reading a lot about this on the internet the last two weeks, I understand that one may get unspecified urethritis also from stress or from using the wrong soap/cleaning yourself excessively (which I did after my encounter). Therefore, even if you do have unspecified urethritis, it is not certain that you received it sexually. I would guess (and hope) that the chances of getting it from protected oral sex is next to zero. My doctor (STD specialist) told me that he had never had a patient who had caught an STD from protected oral sex.

I know it is hard, but try to let it go, and perhaps the symptoms will too. Good luck!

[howthehell]

Thank you all for your comments. It helps to take the edge off. Yes I was tested for other STDs but all were negative. I failed to mention one important symptom though. Don't know if it will affect anyones analysis. During all of this I had 2 different periods of time, 1-2 days each, were I experienced signficant changes in body tempture, i.e., chills. Hopefully this can also be written off to anxiety. From a mental health perspective this is a true help. Still looking foreword to the Doc's view. Thanks again everyone.

P.S. Mathew, I hear you man. I have learned an important life lesson from this and feel more committed than ever to my relationship. Sometimes you just have to learn that the grass is not always greener. Good luck.

[howthehell]

Thank you for your in depth response but I would feel more at ease with a few clarifications. Do you perceive a reason to abstain for sex at this point? Also,  although, not asked in the posting what is the average (granted herpes is bit more unpredictable than most) time before IgM is produced?  Would six days have been long enought, in light of percieved sypmtoms on day 3?  Would a very healthy body need longer or less time to begin to produce such antibodies? I recognize that many of these are questions that should be presented to my doctor but as I am in a foreign country at the moment, satisfying in depth answers have not been forthcoming. Which is why I have resorted to your service instead of putting my full faith in my personal doctor, which is my normal practice.  Thanks for all your help. It is appreciated.

[H. Hunter Handsfield, M.D.]

You're welcome.

Nobody can say for sure you aren't incubating an STD that will show up soon; therefore neither I nor anybody else can guarantee you don't have something you can transmit to a partner.  But the likelihood of that seems low, especially for herpes.  But I'm not going to tell you whether to abstain or not.  Anyway, if you're going to have sex in non-committed relationships, you ought to be using condoms anyway (as you surely know).

Because IgM testing is so unreliable, I have never even tried to learn how quickly IgM antibodies appear.  My guess is that most people with new herpes would have detectable IgM antibody within a month, but that literally is a guess.

HHH, MD

[howthehell]

Dr. Hansfield
I know that you are incredibly busy and if you do not repsond it is completetly understood.  Compared to many other postings you are short on reinsurances. As someone suffering a certain degree of anxiety over this some measure of reinsurance would be helpful (if it can be  made). What other possible STDs should I be aware of? That may correlate with my symptoms. How powerful is the mind in causing these symptoms or at least my perception of them?  What health measures should I be taking other than meeting with the doctor here? Any and all advise is greatly welcomed as it now has been 18 days and I have yet to relax and move on from this event.  Thank you for this service.

[matthew78]

Fehler: I sympatize very much with your situation. In my comment earlier I told you to relax, but my experience is that this is very hard.  Today I went to the doctor and persuaded him to give me a one-week prescription for doxylin, which should kill off any bacterial infection in the urethrea if that is what I have. As a non-professional I don't want to advice you about which drugs to take, but personally I had to take action even though my doctor told me not to worry.

I still cannot separate imagined pains from real ones, but after reading on an internet site that people with non-specific urethritis should not have any sexual activity (including oral) even with a condom, I put two and two together and concluded that there was s slight possibility that my symptoms were caused by an STD. I decided to eliminate this possibility by getting treated with antibiotics. The good news is that antibiotics are supposed to be effective against non-specific urethritis, and what's more, you most likely will be totally cured after treatment.

By the way, where in Europe are you (your nick suggests a German speaking country)? I live in Scandinavia, and here diagnosis and treatment of STDs are free of charge. That could apply to your resident country as well. Possibly there are also someone you can talk to about your anxiety over this matter (also free of charge).

As for the mental health: 1. You are not the only one to do stupid things, but you will be one of those who don't do it again 2. You have told your girlfriend about it, and she hasn't left you. 3. You haven't given any STDs to your girlfriend. 4. You will get well, if you at all are sick.

Once again, good luck!