Please Help me Understand Test Results

[Tom3131]

About 2 weeks ago I noticed a red chaffed area on the shaft of my penis, upon closer inspection I noticed a bump under the skin.  I went to the doctor who diagnosed it as falliculitis, but sent me to the lab for a full std screening "just in case."  The results came back negative for everything but herpes.  They sampled my blood on 9/13/07, the sexual encounter I had which would have given me herpes was an irresponsible one night stand without protection on 7/2/07. The IgM test says Detected. The second test was Herpes AB 1&2 IgG the results were:
Herpes Simplex 1 : 0.21 (EIA value)
Herpes Simplex 2 : 0.11 (EIA value)
a negative result is listed as <0.90.

From these results my Doctor told me I have herpes, but should come back in 2 months for a retest to find out which strain.  I've seen that it takes up to 16 weeks for people to develop IgG antibodies, but after 10 weeks shouldn't the numbers on the IgG at least be a little more elevated?

To compound this now I feel I may be having more legitimate symptoms of a herpes outbreak but I am not sure if I'm just being hypersensitive do to my diagnosis.  I thought I've had a jock itch in the pubic hair around the base of the penis and have been spraying the area with antifungal spray.  The areas don't itch anymore, they burn.  The skin isn't red, and i don't notice blisters but the skin does seem bumpy, I just cant tell if the bumps are around hair follicles or not.

Please at this point what should I conclude, and what should I do?

[H. Hunter Handsfield, M.D.]

A "red chafed area" of the penis doesn't sound like herpes, and a provider thought it didn't look like herpes, so I'm not sure why HSV diagnostic testing was done.  Your more recent symptoms also are not at all suggestive of genital herpes, which does not cause diffuse burning/itching of the skin, and never causes symptoms that last more than 1-2 weeks at a time.

In any case, your blood test result is totally negative.  Presumably your doctor apparently now suspects an early herpes infection because of the IgM test result, but that is irrelevant and almost certainly he is wrong.  IgM testing is meaningless.  For more information on that, see another thread posted earlier today:  http://www.medhelp.org/posts/show/307483. ; As suggested there, you can also use the search link to search "IgM" for many discussions over the past couple of years.

It can indeed take 4 months for HSV antibody tests to become positive. Your results are at least 90% definitive, but have another test (IgG only!) after 4 months if you remain concerned.  You can be confident the result still will be negative.

Regards--   HHH, MD

[infoseekr411]

Hey, glad you decided to move your question to the "ask the Dr" forum.

I am sure that he will give you clarification on your results and expand on the information I gave you in the other forum. He is awesome and very detailed in his responses.

Good luck.

[Tom3131]

Sorry for not including this in my original post, but if I go to the doctor again, will a virus serology conclude anything if I don't have blisters or or open sores, just the burn/itching skin like i described?

[H. Hunter Handsfield, M.D.]

Makes no difference.  You don't have herpes.

[MMafan]

I mostly hear IGM is meaningless because it


1. doesnt distinguish between hsv 1/2 infection
2. can cross react with other virus(though I think youd know if you had shingles or mono right?)
3. if you have hsv 1 chronic it can show up as a new infection on the IGM.
4. or not show up at all even if you DO have a new infection

however, in this case he has neither  hsv 1 or 2 IGG  to cross react yet the igm is showing up as detected.  

is THIS type of false-positive also common with the IGM test? reading thru the forums it is the least mentioned when it comes to errors.

[H. Hunter Handsfield, M.D.]

Statements 1, 3, and 4 are correct.  Statement 2 is wrong.  Non-experts (e.g., health care providers) often describe cross reaction with other herpes group viruses as a reason for false positive HSV IgM tests, researchers in HSV diagnosis have shown that cross reactivity is not an issue.

It is very common for HSV IgM tests to be falsely positive in people with no IgG antibody.