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possible primary herpes infection and 30 weeks pregnant
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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possible primary herpes infection and 30 weeks pregnant

Doctor,

I am 30 weeks pregnant and in an ultrasound 11 weeks ago, my doctor noticed calcifications in the fetus's abdomen which led to me taking a variety of different tests all of which thankfully came out negative, except one. One of those tests was a TORCH titers blood test which I took 6 weeks ago. It came back that I was negative for herpes 1 igG and herpes 2 igG but positive 1.21 for herpes 1/2 igM. She said she needed to do the igM test because recent infection needs to be known because it can put the baby at a much higher risk for infection. She suggested I retest in a month to see what the numbers do. I just retested last week...1.42 igM but still negative for igG's in both kinds. I've done the research and know that igM tests have high false positive rates, but why did mine go up then? If it was a false positive shouldn't it have stayed the same or even gone down?.

I haven't had any symptoms of herpes, my boyfriend of 5 years has never had symptoms, and the only possible encounter I may have had with herpes while pregnant would be sharing (1 use) of a friend's chapstick who has had coldsores in the past but did not have one then nor get one since (this was about 9 weeks ago). The Perinatologist says the postive herpes test has nothing to do with what they noticed in the ultrasound but that it just adds one more thing to be concerned about because only igG antibodies will get to the fetus and protect it from catching the virus while IgM does not. I have not seroconverted.

here are my questions;
1. what is the likelyhood that the igM test was a false positive despite the numbers going up?
2. I have had mononucleosis and chickenpox in the past so could that have interfered with the results?
3. what is the likelyhood that I caught herpes from that chapstick?
4. should I retest again? If so, 3 months from the chapstick incident?
5. I heard that the igM introduces the blood to a herpes coctail that includes a number of different herpes viruses not just symplex 1 and 2. Is this true?

I know that my topic has been discussed in your forums before but given that I'm pregnant and need to know if it is a recent infection ahead of time so I can take the necessary precautions (cesearean) in delivery, I hope that you will please ablige me with answers to my questions. I'm so scared for my baby and my doctor doesn't seem to have any answers.


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Greetings.  I'm glad you got in with your question.  It's an important one and I'm happy to help.  The bottom line is that you can relax; it is virtually 100% certain you do not have HSV of either type.  Your doctor is wrong about the IgM test for HSV.  Health care providers are routinely taught that IgM antibody appears early in infection, and therefore that a postive IgM test, with negative IgG, means an early infection is present.  Unfortunately, it just doesn't work that way with HSV in adults:  most infected people develop IgG antibody just as fast as IgM.  Further, and most important to your case, false positive results are very common with IgM testing.  In 30+ years in my STD clinic, we have never once ordered an IgM HSV antibody test:  it is simply useless and should never be done.  In case your provider doesn't believe me, print this out and ask him/her to search the medical literature for papers on HSV antibody testing, especially several publications in recent years by my friend and colleauge, Dr. Rhoda Ashley Morrow.  She is the world's expert on HSV antibody testing.  Also, your ObG could consult with an infectious diseases specialist about this.

Also, your IgM result did not go up.  The variation in number, especially in false positive results, has to do with the technology of the test, not because of antibody in your blood.  Truly, you don't need to worry about it!

So the bottom line is that you can be sure you don't have an HSV infection.  Unless you are unlucky enough to acquire a new infection in the next few weeks, your baby is not at risk for HSV.  Now to your specific questions:

1) Almost certainly the IgM test was falsely positive.

2) Past mono and chickenpox are irrelevant to your blood test results.

3) Zero; you didn't catch herpes from anywhere.

4) The only possibly useful retesting is to have a Western blot HSV antibody test.  That's the gold standard, the final tie-breaker in herpes testing.  The only place it is done is the University of Washington clinical labs in Seattle--because it was developed there by Dr. Morrow.  I don't think you need this, though, unless it will further help relieve your anxieties.

5) Non-experts often assume that is the reason HSV IgM tests give false positive results, and many website (and some health authorities) say this.  But that's not the reason.  It is related to the nature of the IgM antibody molecule and the technology of the test--that's all.

Bottom line:  Rest easy about herpes with respect to your baby's health.  All will be well.  I hope this helps you have a truly happy holiday season!

HHH, MD
4 Comments
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the previous post is for the doctor
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Avatar_n_tn
Hi, I'm sorry I can't help much but I wanted to say everything will work out ok for u and baby........I'm 31 weeks pregnant and my boyfriend cheated on me and let a stranger give him oral sex, in which he got gonorhrea which i got. We were both treated for this and doc says baby will be ok, because the infection is gone and I am having a c-section.  I worry about HIV infection but he was tested at 4.5 weeks after encounter and from what doc says thats conclusive. I wish you and your baby well!!!!
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Avatar_n_tn
Thank you. :)

Happy Holidays

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