High IgG results and new oral infection

[Fallof11]

I was diagnosed with HSV-1 about a year and a half ago (genital infection- i had symptoms, positive culture, and then got the positive IgG results a couple of months later.) I had never in my life had a cold sore in my mouth at all so this was purely a genital infection. About a week ago however i got sick, and thought i just had an upper respiratory infection with swollen tonsils. Then i noticed white patches all over my mouth, and promptly went to the Dr. who said it looked like a herpetic infection. I told him about my history of genital HSV-1, and he procedeed to do another IgG test. My results came back positive for HSV-1 (not a surprise) and the IgG number was 56. He told me the normal range is 0.0 - 0.8, which is true according to everything else I've read. My question is this - The dr. never did an oral culture or anything, so is there a chance that the lesions were not actually a herpetic infection? Or does it mean that since my IgG results were so high that it definitely was an oral herpes infection? It was not painful at all by the way, and i didn't feel any of the typical symptoms such as tingling, etc. like i do with genital outbreaks. Also, from what i've read this IgG number (56) seems very high, does this mean anything in particular? The doctor said that when you're infected with herpes and it is in its dormant state, the number shouldn't be greater than 0.8, so he seemed to think that the reason it's so high is because of the recent infection... is this true? It may be helpful to mention that about a week prior to the oral symptoms i had just recovered from a genital outbreak. I'm just confused as to what my oral symptoms really were, and if it was herpetic, how in the hell it got there. I'm very careful, wash my hands, etc. And like i already mentioned, had never had a cold sore orally before. And all my tests before getting diagnosed last year had always been negative, so when i got the diagnosis last year, it was purely genital, not oral. Any help would be greatly appreciated, thank you very much.

[gracefromHHP]

they wasted your time and money by ordering a non-type specific test.    they knew it would come back + since you know you have hsv1. Absolutely nothing else that can be ascertained from it other than incompetent medicine :(   The actual numeric result itself is meaningless.

[Fallof11]

LOL...thanks grace for the amusing comment. No he didn't do a swab for strep or anything else, and i have definitely had the white patches on my tonsils before whenever i get strep and other viral infections like that, so i wasn't very alarmed at that. But i hadn't ever before gotten the white patches along my gum lines like i did this time, and they weren't painful or anything just annoying, it only hurt to swallow because my tonsils were so swollen (but for me that's a recurring thing - i need my tonsils out very badly). So i was very surprised to hear his "diagnosis" of a herpetic outbreak.

You do make a point though - the test that he used was not type-specific, therefore it said 56 HSV1/2 (it was a combined result, but i know its only HSV-1 that i'm positive for, because of many previous tests that i had done back when i was diagnosed a year and a half ago, and i have definitely not been exposed to type 2 HSV or anything else since then). Is there a significance in that this test was a non-type specific HSV test? I didnt really think so since i already know what type i have...but are you thinking that since it's a combined test my number was so high because it was both types added together? I'm very sure i dont have type 2, so im just a little confused?

[gracefromHHP]

are you sure that wasn't a combined herpes igg result or an igm result?

as was already pointed out, the doctor erred by not doing a lesion culture. Of course your hsv1 igg was going to be positive since you have it genitally already!!

odds are if this was an oral recurrence of a previous hsv1 oral infection, it wouldn't have presented on your tonsils anyways. odds are it was another viral infection. did they swab for strep at all?   lots of strep going around as well as a viral infection that causes white patches on the throat as well as other flu like symptoms ( just got over it myself too...ugh ).  

Be sure to give your provider your "nasty nurse" look ( sometimes known as the hairy eyebrow....he he he ) and ask him why he thought blood testing was appropriate for active symptoms too!!!  If we don't learn them, who will?  :D

grace

[Fallof11]

Thank you very much for your thoughtful reply. I myself am a nurse and was a little bit skeptical of my dr's answers. However i have not been able to find much research regarding what the number of IgG antibodies really means and since the doc seemed a little bit alerted at the high number and i hadn't seen that high of number before, i also became a little bit scared. But from what everyone on here is saying, i think you're right and the number merely relates to a positive result.

I am hopeful it wasn't an oral outbreak and since i didn't have any pain or other typical symptoms my first thought was that it might be candidas or even what you said, stomatitis. The doc put me on the antibiotic levoquin and also on acyclovir of course, and in a week's time it was all gone, so i really can't say what it was that cleared it. He seemed to think it was a bacterial infection mixed with the HSV outbreak. I'm not sure, and i do wish he'd done an oral swab. Either way i guess i'll know the answer if i get this again.

Again, thank you for your answer, it made me feel a lot better and it's just nice to know someone else was thinking along the same lines that i was.

[bobrope45]

The result number is not related to severity of infection. It just means that, if above 0.8, you have herpes antibodies, which means that you are infected with the virus. Your doctor is outdated when it comes to herpes testing.

Since he didn't swab your oral lesions (again, not the most appropriate thing to do, since a mere visual diagnosis is not recommended), no way to know if it was a herpetic outbreak or not. But the white patches you mention sound like stomatitis, which is common during viral/bacterial infections of the throat.