Very Confused about Everything

[sunguy101]

Dr., I am uncircumsized and had unprotected sex with a girl. Days later I had red spots under my foreskin and my penis was very tingly. I had an IGM test done 10 days after possible exp., it came back negative. I took an IGM and IGG test at 6 weeks. The IGM came back positive at a 3.24 and the IGG was negative. I was then told that I had herpes an my IGG will turn positive. At 10 weeks I took an IGG test and it came back Negative, and then also at 12 weeks it was Negative for both IGG 1 and 2. I then had what appeared to be an outbreak at week 13-14. I woke up to the under side of my penis itching like crazy and it went down the seam of my testicles and was very inflammed. I itched it and itched it and it broke the skin and was very wet. I waited too long to get it swabbed but did so about 5 days after. Planned Parenthood told me that it was herpes, but a dermatoligist at a health dpt. who has been doing it for many years said that it wasnt typical herpes lesions. The swabs came back negative. At week 14 my IGG was negative again for 1 and 2! I then got tested at the 16 weeks and it was negative for IGG again. Being so confused I took an IGM test again, thinking if I dont have either in my system I would be in the clear. The IGM came back at a 2.94. I took a IGG at 5 1/2 months and it was Negative! I now have a pimple on my penis that faded away but had been there for about 3 weeks. Its about 6 months now and my lymph nodes in my armpits and jaw are swollen. I feel pain in my legs and butt and sometimes my toes on one foot go numb. I have been extremely depressed.
1) Would my IGM test at 10 days detect an infection?
2) How could my IGM jump from a negative all the way to a 3.24 in a lil over 4 weeks?
3) Is my positive IGM at 17 weeks positive because the 14 week possible outbreak was an outbreak and its flaring up the IGM?
4) Do you believe I have genital herpes with my symptoms and test results?
Please help, and thank you so much for your time and knowledge.

[Edward W Hook, MD]

I have to disagree with your doctor and your assessment.  In the face of negative IgG tests, this is not HSV.  Your experience and concerns are a great example of why getting HSV IgM tests is a wste of time which is more likely to caused trouble than to help.

No, genital herpes would not cause swollen lymph nodes under that arms.  EWH

[Edward W Hook, MD]

This will be your last answer.  You need to address your fixation on HSV.  There is NO evidence that you have it.  

You can get commercial labs to send serum to the University of Washington for a Western blot if you think you must.  Alternatively, you could take the money the test would cost and light it on fire.  There is no evidence that you have HSV.  i would work through this with the psychologist you saw before.  Instead of referring you elsewhere he/she should help you work through your unwarranted fear of having HSV.

Rather than continue to feel your anxiety, this will end this thread.  I wish you luck.  EWH

[sunguy101]

Dr. Hook,
    My IGG came back negative with the past tests and I was told I don't have herpes by the Dr. I then went to see a psychologist and explained to him that I cant get over this because I need to know what my symptoms are from if it is not herpes. He recommended I see an infectious disease specialist. I did and he re-tested me no more than a week after my last test, even though I had told him I had just been tested. He tested me for IGM and IGG.  My IGM was detected and my IGG HSV1 titer was .08 and my IGG HSV2 titer was .10. This is 7 months out after possible exposure. What can I take out of these numbers? The nurse told me I had herpes for a long time and I quickly corrected her and asked to speak to the Dr.. She said she would talk to him and call me back. She called me back and said that the Dr. said it was a false positive. Since then I went running and got 3 small blisters on the bottom of my testicles from wearing too tight of boxers. I have ran plenty before and never had this problem and had the doctor look at it and she said that it was just from the running. But why would it make 3 little blisters and not just one? I also now sit here with very small erosion like bug bites in a perfect line on the top end of my testicles. They itch and are very annoying and have been here for about a day or 2. I am going to go to the Dr. again tomorrow to show her and i know all she is going to say is that it is not herpes because of the tests. She wont even consider it, but she cant tell me what any of these symptoms are, or how to cure them. I have showed them so many pictures of all my outbreaks and they cant help me at all. I need to take the UW western blot but no one will perform it for me. How can I get someone to do it for me! Can they send me to LabCorp or Qwest to do it? I have the paperwork, just no one will do it. Is it possible that even with my negative IGG that I could still have herpes. Sorry for the questions, I am just so desperately in search for piece of mind. Thanks for listening Dr. Hook.

[Edward W Hook, MD]

No, I have not personally had anyone who has developed a positve HSV IgG after being negative for 5.5 months.  I woul point out however that the more you test, the more likey it is you will have a false positve IgG test.  

I hope you'll come to peace with the fact that you did not get HSV-2 from the exposure you describe.  EWH

[sunguy101]

Dr. Hook,
    Yes I would! I just recently received insurance and now am explaining my case to another doctor. I went in for a physical and told her about all my concerns and problems. She is doing a full panel of tests on me and I told her I wanted to do the western blot and even brought in the paper work for it! She told me I was over-worrying and didn't need it and that the lab tests were good enough. I brought in my records of my past tests and she had no clue how to read them. She was telling me that my IGM was positive so likely I have it. Then I told her how she was wrong (politely) and explained it, though she didn't really listen. Its amazing how the medical field has no clue that the IGM is not reliable. She took blood for an IGM and IGG test and I will get those back in a week or less. As I am hoping the IGG will come back negative and the IGM will come back positive and this Dr. will be as confused and not know what to do. I don't know why she wouldn't order this test for me, but I will unfortunately need it for piece of mind as I do not want to infect anyone else If I do have it. Have you heard of a case where the IGG test is negative for 5 1/2 months and turns positive at the 6 month mark? If this is negative and I end up not having this, who should I see next to clear up the random tingling and pains? It seems that no one has ever suggested anything else!
Thanks for all your help Dr Hooks! Wish me luck on the blood test!

[Edward W Hook, MD]

You have a positive IgM which is a meaningless test.

You have multiple negative IgG tests- these are reliable.

You have a negative culture.

You have a clinician who diagnosed you clinically. Studies show that STD experts are wrong over 20% of the time when they make a clinical diagnosis.  

There are many other things (dermatological problems) that can cause problems of this sort, mimicking herpes. That is the reason we use the tests.

Putting all of this together, I remain unconvinced you have herpes.  The IgG test missed about 3% of proven herpes when compared to the Western Blot assay performed at the University of Washington. You could ask your doctor to send this test off (but only to UW, it is as close  to a "gold standard" as there is for a herpes antibody test).  If you order this and it is negative, will you then believe the answer?  I hope so. Please let me know the outcome if you choose to go this route.  EWH

[sunguy101]

Dr.,
   I have constant itching and pains in my penis. I have every symptom of genital herpes from rashes, pimples, itching, tingling, and inflammation which has occurred from time to time within a few days from unprotected sex with a promiscuous girl, to now 6 months later. I had an IGM that escalated from a negative to a 3.24 positive in just over 4 weeks. I had a nurse practitioner tell me that it was genital herpes, though you insist there is really no evidence that I have HSV. I understand that this conclusion must be strictly based on my negative IGG's but that leads me to question the IGGs accuracy. Is there any way that my body would not produce these antibodies? Should I retest at a later date beyond my 5 1/2 month negative IGG? Is there another test that is more accurate than the IGG test that I should take? What else could it be? This problem is constantly affecting my life and I need to move on, though I am having a a very troublesome time doing so. Any ideas on how to get a final answer on my herpes diagnoses so that I can put my mind at ease and basically get my life back?
Thank you again Dr. Hook for your insight and time, I am more than thankful.

[sunguy101]

Thank you for you reply Dr. Hook,
   What concerned me Dr. was that my IGM tests came back at such a high reading. I was told that sometimes the chicken pox virus could set off the IGM to be positive and it would be around the equivocal to 1 something range. But after the IGM being negative after 10 days, it was as high as a 3.24, 6 weeks after possible exposure (4 weeks after the negative one). I am confused that the reading jumped so high. My tests haven't really bounced around. All of my IGGs have been negative from 6 weeks out to 5 1/2 months. Though my IGM went from negative to positive. I know that everyone says IGMs are worthless but the reading went from negative to very high in 4 weeks and I haven't really even received an answer on why, and it scares me. Is there no evidence that I have HSV if I have been told by a Dr. that she believed it was to be HSV, and what about all of my symptoms. Also with HSV would my lymph nodes under my arm be swollen? Thank you for your help Dr. Hook. Your help is the only happiness I will probabley get out of my day.

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  From what you tell me, you have no reason to think your partner had HSV and even if she did, the fact is, only a very small proportion of exposures lead to infection.  

Further, there is no meaningful evidence that you have herpes.  We do not recommend IgM tests for HSV diagnosis because the cause precisely the sorts of problems you are experiencing.  The currently available IgM tests for HSV have very, very high rates of false positive results and the fact that your tests have been positive for so long without development of an IgG response is convincing evidence that your positive IgM tests were falsely positive, perhaps due to prior infections with non HSV but related viruses such as chicken pox.  The fact that the test results have "bounced around" in the way you report also is further evidence that this is not HSV

Between your repeated negative IgG tests and your negative cultures at a time when, if you have HSV you should have had a positive test is very strong evidence that this was not HSV.  

Try to relax.  There is really no evidence that you have HSV.  i hope my comments will prove helpful to you.  EWH