igg vs. igm (Do I definitely have Herpes)?

[JA40]

Hello Dr.'s,

I've seen several posts about Igg vs. Igm HSV testing and am 100% clear on Igm being inaccurate, worthless, etc. in finding out if an individual actually has Herpes 1 or 2.  A type specific blood test such as HerpesSelect is recommended by the CDC (Center for Disease Control) and I understand they (CDC) actually discourage Igm tests as well.  Before getting to my actual questions and concerns I wanted to describe my situation (i.e. potential Herpes symptoms)

I developed Herpes related symptoms about 2 weeks ago which began with a burning sensation when urinating...sometimes at the onset of of urination, sometimes during, and sometimes after.  I was tested (urine) for Chlamidia and Gonnorea (sp.?) the same day of my symptoms which came back negative.  About 4 days later I still had the burning sensation while urinating and went back to my doctor.  He gave me another urine test (negative again for Chlamidia and Gonnorea) so he diagnosed me with Urethritis and gave me a shot of Recophin in my butt and one dose (4 pills) of Azithromycin.  Two days later the pain while urinating was extremely better (from the antibiotics???), but I then developed a small scab on the shaft of my penis followed by another 3 scabs within about 20-30 minutes so I went back to my doctor... these were not blisters or open sores and still aren't...they literally developed as scabs before being an open blister or sore.  I know this doesn't make much sense, but being the obsessive compulsive individual that I am I would've noticed blisters or open sores on the shaft of my penis since I was constantly examining my genital area every hour or two due to the burning sensation while urinating.  My doctor thought it was most likely Herpes and ordered a blood test and prescribed Valtrex.  The scabs have been around now for about 5 days and are better, but still there.  No pain at all around the sores/scabs, no new ones have developed, and the burning while urinating is completely gone.

I received my blood results today and my doctor believes I have Herpes due to my string of symptoms and positive Igm blood test.  My Igg for both 1 and 2 is negative. So my first question is do I most likely have Herpes?  I've been told that in about 90% of Herpes cases in men the scabs/sores are very painful...again I have no pain???  Also, the burning in my urination seemed to get better from the antibiotics and is completely gone...the antibiotics wouldn't make Herpes symptoms better, correct?  And again, the scabs/sores are still there but definitely better and still no pain.  I have not begun the Valtrex medication because I'm not certain I have Herpes since my symtoms are better.  All of this coupled with the fact of a postive Igm for antibodies and negative Igg on Herpes 1 and 2 has me confused.

I understand Igm testing has been known to detect "early phases" or "recent" infection of Herpes, but several threads on this site say to disregard the Igm completely...would you suggest I still dismiss this test given my symptoms?  Could it be anything else? Some sort of other infection...maybe male yeast infection? Or some sort of skin condition coupled with urethritis?  Could the antibiotics in my system (Recophin and Azithromycin) be causing the positive Igm?  

My girlfriend just took her blood test and I believe it's a HerpesSelect so Igm will not be tested.  Needless to say I'm trying to figure out timing concerns and if I do have Herpes if she infected me with the virus.  We've been in a monogamous relationship for 7 months and I haven't been with anyone else.

If she tests postive on the HerpesSelect Igg she obviously could have been a carrier for quite sometime without any symptoms and never knew she was infected.  In this instance given my negative Igg and positive Igm if I test later and come up with a positive Igg she would be the individual who infected me, correct?  If she tests negative like I did on the Igg we both plan on being re-tested in about 3-4 months.  If at that time we both test positive would it be safe to assume she was infected by someone else during the first 7 months of our relationship?  I say this because one of us would've had to contact it somewhere and I most certainly haven't been with anyone else but her.

Thanks in advance for the response.  Anyone else out there please respond if you can add some insight...appreciate it.

JA      

[auntiejessi]

Hi there -

Absolutely, totally disregard the IgM.  Totally factor it out of the diagnostic process.  It should never have been drawn on you.

It reacts when it shouldn't, and doesn't react when it should.  When I got my positive IgG for type 2, my IgM was also reactive, which makes no sense.  Your other meds wouldn't cause it to react, it just doesn't work the way its supposed to for herpes.  (Other IgMs for other conditions really do work, it just doesn't for herpes.)

Actually, 90% of EVERYONE who has herpes won't have big ugly symptoms.  90% of those with hsv2 don't even know they have it because their symptoms are so mild.

At this point, the best you can do is wait for your gf's results.  If she is negative, and you are also negative, this won't be herpes, and there would be no reason to test again in 3 or 4 months if you've been monogmous for 7 months.  It would have already shown up on her test if she had it before, and it would show up on yours if you did.

AJ

[JA40]

Thanks for the response AJ.  I've obviously already been tested on the Igg which came back negative.  However, when I was tested I only had potential Herpes symptoms for about 8 days.  It is possible that the Herpes in my blood just hasn't manifested itself yet, right?

And if we both come back negative now couldn't she be in the same boat in that she was recently exposed and it just hasn't shown up in her blood yet?  She hasn't given me any reason not to trust her, but if she wasn't faithful this could be a possible scenario, right?

And if we retest in a few months after both being negative now and something comes up positive then one of us had to be unfaithful because it had to come from somewhere, correct?  

[auntiejessi]

Right.  If this is a new infection for you, your IgG would be negative now.

If you both test negative now, and positive later, then someone had to have gotten it from someone else recently.

Don't jump to conclusions though.  This isn't enough to suspect cheating, ok?

AJ

[JA40]

Trying not to AJ...thanks for the support!  Haven't received gf's results yet, so still holding out hope that she comes back negative on 1 and 2 and then if we retest in 3-4 months same results.  One quick question though...even with my "potential" symptoms would you say it's still safe to ignore the igm test?

[stillHurting]

I have a bit of a different perspective here.  

For one, IgM being present when IgG being present is actually not that unusual.  For some people, even far after the first time they were infected, their IgM will reactivate when the virus becomes active again.   So while I agree that using IgM to say that an infection is recent is poor at best, having both at the same time is not that unusual.  You probably know that, but I bet that JA40 does not.

The other thing I will say is that while IgM is pretty unreliable, so is culture.  Actually, culture has a worse false negative than IgM tests do.  However, it does have a better false positive rate (it's very low).  Anyway, the odd thing is that culture is still used, and nobody jumps up and down and says it's worthless.  But it's totally unreliable.  I suppose the difference is that the psychological impact of the false postives with IgM is seen as worse than false negatives with HSV culture. I'm not sure.  What I do expect though is that there have undoubtedly been many people who got a culture, got a negative, never followed it up with an IgG test because they thought they were out of the woods, and unknowingly spread HSV.  I think that's really a shame.

In summary, while I would certainly not make a diagnosis on an IgM result, and I wouldn't test myself that way nor recommend anyone else be tested that way, I do believe the test provides a clue at the diagnosis and so can be somewhat useful, especially in the early stages.

But be sure to post back and let us know.

[auntiejessi]

If the culture is positive, and typed, its the gold standard for testing.  Unfortunately, it does have a high false neg rate.

The IgM is more unreliable than reliable, and it has sent many people I know into a years- long tailspin of anxiety and testing, and while some people do have both positive, its not supposed to work that way.

Here is a great explanation, in lay terms, about why the IgM is unreliable, and shouldn't be used on adults.  Its by my friend Gi, over at the herpes homepage:

"In layman terms, the IgM antibody is general purpose, helping to fight off all sorts of meanies. So if you test IgM positive, it doesn't mean it's there because of HSV. It might be there fighting something else, or maybe it is fighting HSV. Thus the worthlessness part.
IgM antibodies may or may not show up for a primary infection, and studies have shown they'll show up in 35% of recurring outbreaks. Thus the unreliable for detecting new infections.

You'll hear people say it cross reacts to ChickenPox and other viruses. This is incorrect and was explained in another post here where Dr HH Hunter quoted either Anna Wald or Rhoda Ashley-Morrow about the issue being the mechanics of IgM testing and its deficiencies. It far easier to just say it cross reacts then getting into the trenches of sub-particles and proteins.

The gG-1 and gG-2 antibody is specific to HSV1 and HSV2 respectfully, making the IgG type specific test the better mouse trap.

Clear as mud huh??"

If you want to read the whole thread, its here - http://racoon.com/cgi-bin/dcforum/dcboard.cgi?az=show_thread&om=20199&forum=support

AJ

[JA40]

Thanks for the further clarification AJ.  So my gf's results came back today and she is HSV1 positive as suspected due to her cold sores as a child and through high school.  She hasn't had any cold sores in about 5-6 years though...not sure if this means anything.  Her HSV2 was negative.

Now I'm wondering what I should do next?  I'm assuming I should retest in 3 months to see if I have in fact been infected.  At this point I have the "detected" Igm test and negative Igg on HSV1 and HSV2.  Should I still disregard the Igm given my potential symptoms?  Please review my symptoms above for more clarity.  I'm thinking about going to a urologist to see if this could be something else.  Given my symptoms is there anything else it could be?  How likely is it that she could have infected me with her HSV1 on my genitals?  Does this happen much or is it somewhat rare?

My biggest concern is when my gf and I retest in 3 months.  If one or both of us test positive for HSV2 it's certain that one of us has been unfaithful and has recently been infected since we're both Igg HSV2 negative at this point, right?

[auntiejessi]

Actually, 30% of all new genital herpes infections are type 1, from someone with oral hsv1 performing oral sex on someone.

Yes, if her next test comes back as type 2, then its a new infection - at least within the last few months.

Don't jump to that yet.  Again, this is not nearly enough info to suspect cheating yet.

AJ