IgM Test Positive, IgG Negative.

Timeline:Mar 27 2010–Began taking antibiotic Minocycline for acne. 28th –I had unprotected sex with a guy who had many partners. He claims he gets tested regularly; last time he had gotten tested was Febuary & was negative on all STD’s including Herpes. Apr 7–Notice kind of a pimple somewhat near vagina. Large for a herpes outbreak, it hurt like normal acne. In a few days there was redness & burning during urination only for a couple of days. I also noticed a little piece/ball-like white discharge. I stopped taking the antibiotic thinking it had caused me a yeast infection. I was also spotting blood for 3 days. 9th– Painful & protected sex with someone who has not slept with anyone else in the past 3 years. Condom snapped while he tried to enter & it was replaced. After sex, noticed ball like white thick discharge. I’ve taken a picture of the discharge on my finger. 14th-17 days after exposure, I got tested for gonorrhea, Chlamydia, syphilis, HIV, Herpes 1 & 2. 20th- Results negative except igM test for Herpes which was +1.40. The lab rep told me that this didn’t mean I will develop the virus; it meant I was exposed to it. Sometimes, I’ve been having lower back, abdominal &sudden tailbone pain. 1) If antibodies are present in my system, does mean I have or will develop the virus? 2) What are the odds that I will fight it off, if I do have it in my system? 3) The rep said I should wait till 90days after exposure to get tested again. Is there anything I can do until I hit my 90day mark to keep my immune system strong to fight off the potential virus?4)Could I have passed the virus on the 9th? Does the temporary light burn during urination, redness, and discharge suggest yeast considering my use of the antibiotics in the end of March? Was the pimple coincidental, or does it sound like a possible herpes outbreak considering it was a little over a week after possible exposure? 5) Can I take Immune Builder and Viraway for herpes to help my body fight it, if I have it?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.

Most important, your positive HSV IgM blood test may be meaningless.  It is inherently unreliable.  Given your negative IgG test, there are two possibilities:  first, you don't have HSV at all, and the IgM result is falsely positive; or second, you do have it and the IgG antibodies just haven't had time to become positive.  Your symptoms were not typical for herpes, and my bet is on a false positive IgM test.  Here is a thread that explains the IgM test in detail:  http://www.medhelp.org/posts/show/248394  Using the search link and entering "HSV IgM" will turn up hundreds of other discussions about it on this forum.

The lab rep you spoke to does not understand HSV antibody testing, and that misunderstanding is reflected in some of your questions.  There is no such thing as being exposed but not infected.  If the HSV antibody test is positive, the person has not only been exposed but is infected and continues to carry the virus.  

To your specific questions:

1) Apparently there are no HSV antibodies "in your system".  But please report the details of your IgG test result.  You also should plan on another IgG test about 6 weeks after the sexual exposure.  That's the one that will tell for sure whether or not you were infected.

2) If you are infected, you will not "fight it off".  All HSV infections are permanent and lifelong.

3) Sometimes it takes 3 months (90 days), but most people with new HSV-2 have positive results by 6 weeks.  If a 6 week test remains negative, a final test at 3-4 months is recommended.

4) If you caught HSV and then had sex while still having symptoms of the initial infection, you definitely could have transmitted it to that sex partner.  But I stress that my best guess is that you were not infected, so probably there was no herpes for you to transmit.

5) Viraway, Immune Builder, and other "immune system boosters" are quackery that will have no effect.  Don't waste your money.  Anyway, even when real anti-herpes drugs like acyclovir are administered as soon as 1 hour after exposure, they do not prevent establishment of HSV infection.  I'm afraid in your case the horse is well out of the barn and galloping over distant fields, so no point in closing the barn door now.  You are infected or you are not, and at this point you can't do anything about that.  

But don't be discouraged.  The odds are you weren't infected with herpes; and if you were, with proper management genital herpes need not be such a big deal.

Bottom lines:  Let me know your recent HSV IgG test results, and plan on another test in about 3 weeks.  In the meantime, try to stay mellow.  Most likely your IgM was falsely positive and you don't have it.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Part of my response was poorly worded:  "There is no such thing as being exposed but not infected."

Of course someone can be exposed to HSV but not infected.  But then all tests remain negative.  I should have said there is no test that indicates exposure without infection.  If an HSV test is truly positive (i.e. excluding false positive results), the person is infected.

[everythingwillbealright]

HSV 1 IgG, Type Spec < 0.91
HSV 2 IgG, Type Spec <0.91

The lab rep also told me that IgG tests indicate I was negative 90 days ago, that the positive IgM indicates if I had acquired the infection, it was recently (less than 90 days ago). By this information, the IgG negative tests are meaningless to me because I'm very certain if I did contract the disease, it was recently, on March 28th. I also told him that I had heard IgM is known to be unreliable, he said I was wrong and that it is fairly reliable and chances were 50-50. I did check out your thread and it does make sense to me now. He offered me a second test and said I would get a discount because I had already tested with them, could it be that they offer IgM tests hoping for a positive so I pay them again for a second test? I'm generally healthy, (have had chicken pox 3 years ago) do you think I should have developed the IgG antibodies (If I'm HSV+) by the time I tested (17 days post exposure) or would that have been typically too soon? Thanks, you've been very helpful.

[H. Hunter Handsfield, M.D.]

Your HSV-1 and 2 IgG results are negative.  The lab rep gave you the "party line" with respect to the IgM test, i.e. the theoretical interpretation of a positive IgM test.  As the other thread describes, it usually doesn't work out that way.  Until and unless confirmed by a later positive IgG test for HSV-1 or -2, your positive IgM result is false.  S/He probably does not understand the IgG test either.  It rarely requires 90 days to become positive, although once in a while it takes that long.  (This is not to blame him or her.  People answering patients' questions about lab tests typically are not highly trained.  They are given a script to read that standard replies to the most common questions.  Most such persons have no detailed scientific understanding of the tests.)

As you saw, the reasons such a poor test continues to be done commonly are discussed briefly in the other thread -- and you don't have to assume the crass motivation you suggest.  Most likely it is just naivete about the test and how it works.

Probably around 30-40% of newly infected people would have positive IgG results by 17 days, so your negative result is only slightly reassuring.  Because most newly infected people have positive IgG results by 6 weeks, you don't need to wait 90 days for another test.  However, if still negative, a 3-4 month test will be necessary as well.  You just need to decide whether you are comfortable waiting until the 3 month mark, or would like to know sooner if you have HSV but with the risk of having to pay for yet another test.

Whatever you do, in the meantime be on the alert for recurrent symptoms.  Repeat herpes episodes typically are much milder than the initial outbreak, often only a very few (or onlye 1-2) small blister-like lesions or sores.  If that happens, see a provider ASAP, preferably within 1-2 days, for direct testing for the virus.  If positive, that's the most definitive way of diagnosing genital herpes.  (If positive, be sure they determine virus type, i.e. HSV-1 or 2.  Some providers and labs don't always take that step unless asked.)

As you described your symptoms above, I would characterize them as consistent with new herpes but not typical.  My bet is you don't have it -- but time and repeat testing will tell.  (If you don't mind a personal comment, it is refreshing to have a question from someone in whom HSV testing is being done for exactly the right reasons!  So many forum questions are from worried-well persons at little or no risk for herpes, many of whom really shouldn't be getting tested at all.)

[everythingwillbealright]

Well, to be honest, I'd rather be one of those who aren't at risk but are still being attentive to their health and asking questions. I should have known better, but I've most definitely learnt my lesson.
I will be taking the test on the 6th week. If it turns out to be negative, I will be a lot more relieved.Of course I will still take the 3rd test.
Quick question, which symptoms that I mentioned are atypically consistent with HSV?
I know yeast infections have a few symptoms in common with HSV; I've been using monistat which seems to have worked on my short-lived mild symptoms.
Also, would it be ok if I tell you my results the 2nd and 3rd time I get tested? It feels good to be able to talk to someone (especially a professional) about this. Thanks again.

[everythingwillbealright]

If they were truly HSV symptoms, shouldn't the IgG test be positive?