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1549643 tn?1495759353

Positive IgM, Negative IgG

Early into last year I had an IgG test done by my gyn and it was negative. I kept getting outbreaks every 4 to 6 weeks. Earlier this week, I had an IgM test done during an outbreak of fever blisters on my lower lip and it was positive.

HSV, IgM I/II Combination 4.58 H
Negative 1.09

If I've had herpes, it would have been contracted over 16 years ago from my ex-husband. We divorced in 2000 and I haven't been with anyone since. I started getting fever blisters after we got together. He claimed his was from an upset stomach, and unlike myself, he had multiple sex partners (unprotected) with probably 50 different women. I am in serious question as to why an IgG test would be negative. It is supposed to be more accurate than an IgM test so why didn't it show antibodies?

I get fever blisters on my lower lip, always same location. It starts out as multiple tiny blisters and I continue to get more, or they get larger. When the blisters bust, it crusts over, cracks, bleeds, and finally goes into a stage of healing. This is usually about a 10 day process and I get very run down during this time. I believe where my immune system is overactive, is why it does that. I also had one genital blister last year.

To me, it seems more than obvious but I cannot get past the IgG test being negative.
24 Responses
101028 tn?1419603004
the herpes igm test is a greatly flawed test and the cdc recommends that it not be used on adults for the purpose of diagnosing herpes. your provider erred greatly on many levels by ordering it to be done on you plus it was a non-type specific igm test too so it was even more of a waste of your money and time :(  

hsv1 orally is incredibly common. Even the best blood tests still miss 1 out of every 10 hsv1 infections but if you get fever blisters, you know you have hsv1 orally.   http://www.ashastd.org/herpes/herpes_learn_oralherpes.cfm  has terrific info on oral herpes for more reading.

if your hsv2 was negative, odds are you don't have hsv2 genitally but from your symptoms you probably have hsv1 orally.

next time you have genital symptoms, be seen within 48 hours of their appearance for a lesion culture and typing just to err on the side of caution.

if you are getting cold sores regularly, have you tried oral herpes antivirals to reduce the number of recurrences?

1549643 tn?1495759353
My Gyn did an IgG and IgM test on both HSV1 and HSV2 and all of those tests were negative, and I wasn't broke out at the time, but I had been getting the fever blisters every 4 to 6 weeks. My doctor did not order the current IgM test. The one I recently saw would not do a biopsy or anything to diagnose it. He guessed many things, like oral thrush, herpes from low immunity until he heard of my test results last year, B12 (normal now), folic acid, low Iron but my CBC is normal, Sjogren's. I ordered this blood test myself since it gives information to an active infection and I had the fever blisters. He put me on antifungal cream, it did not help. I've tried cold sore medication, neosporin, also not helpful. I have not been on any antivirals. Doxycyline stopped these from occuring last year and then plaquenil at 400mg a day. But now I'm on a low dose of Plaquenil and it's returned. I thought it was autoimmune blisters until I did this herpes test. I have a high ANA and RNP and symptoms to go with it. This infection makes me pretty sick, I think any infection has that capability because my immune system doesn't function right. It does seem obvious that I have HSV-1 but the IgG test didn't show it.
101028 tn?1419603004
no the igm doesn't accurately reflect an active recurrence of herpes either. you had your money wasted :(

if you want to confirm that these are hsv1 orally, you'd need a lesion culture and typing done within 48 hours of their appearance.
1549643 tn?1495759353
IgM shows active infection, IgG shows past infection. If I do have HSV-1, it's the IgG that didn't accurately reflect the past infections. I read online IgM can be positive in chicken pox, zoster, and mono, well I don't have any of those. So the fact that the IgM test would be a false positive, then why would that be the case? I do plan to be rechecked at a later time for the IgG test, and have the blisters biopsied next breakout, I tried to this time but the doctor didn't want to, next time, I'm not taking no for an answer. My 2nd day with this infection, the blisters were quite small. It took 3 days before they really started looking nasty and I started feeling sick. Are you sure it needs done within 48 hours?  
1549643 tn?1495759353
I'm going tomorrow to pick up my test results from last year. I know the IgG & IgM tests were done on both HSV-1 and HSV-2 as each one showed negative to both, but I don't know if the IgG test was a specific antibody test, it could have been a combination test like my IgM test I recently had done. Would that make a difference in reliability? I'm also going tomorrow to get a blood test done for HSV-1 herpesselect, just to make sure. If that is negative, I might have the HSV-2 specific test done, and follow up with a biopsy on my next outbreak.
1174003 tn?1308160819
Not sure where you got your facts about the IgM and the IgG testing is so far wrong.

IgM testing can also be falsely wrong because of the chemical used or anything else.  It does cross react with other viruses as IgM is not just made for Herpes.  The fact is no test out there will ever tell you if an infection is recent or recurrent.  A great read on testing from someone who is an STD Expert not to mention a doctor is below.


The fact at this point is you seem to be questioning our advice.  We aren't trying to mislead you or anyone out there.  If the IgM test was as accurate as you and some others seem to believe it to be we would tell you to get tested using that.  The fact is it isn't.  It is flawed and that is why the CDC doesn't recommend its use.  Any true HSV expert will tell you that the IgG testing is the only way to go.  While even our best test (the Western Blot) can miss infections the fact is that is a few rare people.  But no test out there is perfect for anything.

We are sure that the 48hr rule is the best to follow.  The fact is the virus on a culture dies and there has to be enough to grow in a culture.  If you don't get enough live virus on the culture dish then the result is a false negative when the person actually does have it.  48 Hrs is a great window that the virus is still strong enough on the skin to avoid such problems.  Now while the PCR test doesn't require the virus to be alive it does require it to be on the skin but still requires enough virus to be present.  The further out you go the higher the risk of a false negative because the body is actively fighting the infection.  

The combo test would make more of a false positive issue then a false negative just because the IgG results would combine HSV-1 and HSV-2 in the same boat.  If one would be found you wouldn't know which of the two or if was both.  

There is no such test that is type specific for IgM for HSV-1 or HSV-2. There is only one true type specific test for HSV and that is IgG. I would say just do the HSV type specific herpeselect testing at the same time not at two different times.  

1549643 tn?1495759353
I got my info from the lab, it says IgM is to test for active infection, besides it being all over the web, I understand that the IgG should be positive also, or that the IgM could be inaccurate but I don't think that necessarily means it is. I do believe it's likely not herpes if a IgG test is negative. That is why I'm having the herpeselect test done to see if it shows anything this time around, though it should have last year. If these turn out not to be fever blisters from HSV, then what in the world could it be? I know it's some form of infection causing fever blisters, that keeps recurring. I am negative on all STD's except past occurance of epstein bar virus. If my IgG test comes back positive tomorrow, something is flawed with that test too. Will let you all know how it turns out in a few days.
1174003 tn?1308160819
The IgM test from the lab is incorrect.  If you read the link I provided to you then you will get a understanding as to why that theory was put into place about the IgM testing.  

Many things can look or even act like fever blisters.  But the thing is you should get the proper testing and if you have a fever blister be seen within 48hrs for a lesion culture or PCR test.  

1549643 tn?1495759353
I might read it tomorrow, a little tired right now, but thanks. It's just unbelievable these tests would still be allowed to be used.
101028 tn?1419603004
so what if these aren't herpes going on? many things from allergic reactions ( including wheat allergies ) and other infections can cause them. The lesion culture done within 48 hours is the best way to confirm hsv1 orally if your igg blood tests are repeatedly negative for hsv1.

for some infections, the igm does reflect active infection/reactivation of infection but it doesn't seem to be the consistently with the herpes igm. the test is greatly flawed, even the type specific igm tests which is why current cdc guidelines are not to use them on adults for the purpose of diagnosing herpes infections.

best of luck finding out what is going on. perhaps a dermatologist would be a good consult at this point.
1549643 tn?1495759353
Well I need to know if the IgG can be negative if you've had herpes for many years. Is it possible to get a negative IgG and a positive culture for herpes? It's just weird, my ex gets cold sores also, and I didn't get them until we hooked up, and it follows the course of a fever blister, recurs, and it looks and sounds exactly like herpes when I read about it online. I would be surprised if it isn't herpes but I'd be more than happy to find out it's not.

The genital herpes, how does that show itself, is it also groups of multiple blistering like it is on your mouth? The one I had last year was kind of hard but it felt like a blister and went away after a couple of weeks, it wasn't a group of blistering, just that one. I thought about going to a gyn but then figured it was silly over one blister.

My dermatologist retired so I don't have one. I am going to talk to my PCP in august or sooner if another outbreak occurs and get him to biopsy it. The first doctor I saw there should have done so when I asked, and they will do it in that office, but he didn't see it as necessary, even though I get really run down when these infections occur. If my IgG is negative, I'm not taking no for an answer next time, I have the right to know what it is.

And the crazy thing is, him diagnosing possible thrush. I have a white tounge where I smoke and I know it's not oral thrush, but if that doctor felt that way, I'd think he would have done more treatment for me than just having me put anti-fungal cream on my lip, how is that going to cure oral thrush in your mouth? The doctor was super nice, but he really failed at doing his job.
1549643 tn?1495759353
p.s. What is a PCR test?
1174003 tn?1308160819
Even the best testing will miss one out of ten infections.  So yes a IgG test may come out negative and a swab positive if a new infection or it could be just one of the missed infections in people.  Some people will never test positive using a blood test.  

You seem overly worried about herpes for having a partner that does have it.  Yes you may have HSV orally. About half the adult US population has it and we got it as children.  As you were told many things can act like a coldsore to some people but really it isn't.  

Doctors see things a lot of times that may be not understandable by the lay person.

PCR is a testing that looks for the DNA of the virus itself.  It doesn't require the virus to live like the culture method does.
1549643 tn?1495759353
I am worried about it. I had frequent infections last year. Even at one point, it occured 3 weeks between the last occurance, but usually it was every 4 to 6 weeks. I'd get very sleepy, be in bed half the day, wake up, and my mouth would start breaking out. Then the general fatigue I normally suffer with would get extreme, I'd become bedridden, and my pain would increase. It did not stop until I started taking antimalarials, in October, and I quit feeling so run down. Then I caught a cold in January and the antimalarial I was taking stopped working for my fatigue, and I stopped taking it in February, I think. Hadn't had any outbreaks while I was on the antimalarials. Last month I started back on a lower dose of Plaquenil (went from 400mg a day to 100mg a day) and 50mg of Imuran, it was helping me feel a little better, then I get this outbreak again last Sunday, and I have been run down since. The fever blisters are starting to clear up but I am still not feeling well. Whatever this infection is, it is making my health problems worse, and I would like to find out what that is. Even if it is HSV-1, I know it will not explain why I get so sick when the infection occurs, I can only assume that where my immune system is overactive, as if it would be immunosuppressed, that maybe it works the same way, and that it wasn't fighting off these infections because I wasn't getting treatment to calm my immune system down, and my immunity is causing me not to fight this off like it should. I am in limbo with a diagnosis of autoimmune disease. I did get a past diagnosis of Lupus, and then fibromyalgia, and this is back up in question again, but the rheumatologist I saw totally blew me off, she would not acknowledge any of my symptoms, said my pain and fatigue were too vague to mean anything, said I didn't have fibro tender points, that fibro was mostly due to depression anyways, but if she was to guess what was wrong, that would be it. This was based on lack of high ESR in my blood. She also said no medications would likely help me, and meds for autoimmune disorder, it does help. I've been sick for 14 years. If I have HSV, I would have contracted it about 17 years ago. I also find it pretty weird that this happens to me 3 years after developing a possible STD. Maybe a coincidence, well I am sure it is, still makes me wonder. I guess I am just tired of being sick and not having any answers.
1174003 tn?1308160819
The medicine you are taking treats malaria not herpes and wouldn't treat or prevent HSV outbreaks.  

The fact is you have a lot going on.  If you are getting frequent outbreaks of what you believe to be HSV then you need to be see within 24-48hrs to have a lesion culture (not a biopsy) or PCR testing done.  Could you have HSV?  Sure like you were told before and know that is likely by your age you would have it.  Knowing that your partner has HSV it does put you at a risk.

Whatever you have going on is outside of the normal for herpes and given amount of stuff and complexity going on with everything You and Your doctors need to work on this as a team.  If they aren't willing to listen you need to look for another provider.  
1549643 tn?1495759353
I know antimalarials do not treat HSV. But maybe...... just maybe.... they put my immune system back to working more normally, much less fatigue, and thus, reducing the occurence of infections. One of the factors that can re-trigger HSV is being run down. Maybe if someone gets HSV outbreaks frequently, they should have their immunity checked into.

My ex-husband (not my partner anymore haha) was never diagnosed with herpes. But he gets cold sores, does the same thing, blisters, crusts over, and heals. His is triggered by upset stomach but he hasn't had one for quite along time, and I, on the other hand, can't seem to get rid of them to save my life.
1174003 tn?1308160819
The case of being sick being the cause of an outbreak really isn't the case at all.  It however can be due to medicine you are taking.  That is a different story.

An upset stomach won't cause an outbreak either.  
1549643 tn?1495759353
The reason behind why herpes heals is due to your immune system. Reason you don't catch an infection and die is because of your immune system is able to fight it off. A weekenened immune system leads to prolonged infections, slower healing time, and frequent recurrences of infections. I do not know, and doubt it is established by doctors, that autoimmunity is capable of causing recurrences of infections, but either condition, your immune system has malfunctioned. So for it to not play a role in how often you get an infection, regardless if that be a cold, the flu, oral thrush, STD's, skin infections, or anything, I don't see how that would be the case. Why is it that you feel that way? What is it that you believe triggers recurrences? It's pretty much all over the web: prolonged stress, low immunity, fatigue, being run down, alcohol, menstration, sunlight, UV light, extreme temperatures, another illness, upset stomach. I don't know if I mentioned this already or not, but this last outbreak, I was up until 2 am painting, got up really early, the next night up until 3 am and only got 4 hrs of sleep that night, then the next day, the outbreak occurs. I am used to going to bed around 9 or 10, and sleeping all night. I was excessively drained. I had about 8 outbreaks last year prior to taking antimalarials in October and I've only had one this year.
1549643 tn?1495759353
And I mean the herpes sores, I know herpes itself is not curable.
101028 tn?1419603004
at this point all you can do is to continue to follow up with your providers. really not anything else we can add at this point to be honest. obviously you have multiple issues going on at the same time which further complicates things in general.
1549643 tn?1495759353
My IgG herpeselect test was negative again. It's funny to me that I have clear signs and my IgG test cannot come back positive.
1549643 tn?1495759353
I may have already asked this, I don't know, but Grace, you stated the IgM is not consistent with herpes IgM. However, is the IgM consistent with a herpes family type of infections or could it be positive in any type of infection? Meaning if you test positive on IgM, does that mean some form of infection from the herpes family is present there?

When I didn't have the fever blisters, my IgM was negative, but when I did break out with them, it was positive. I know I need a biopsy at this point, but I'm just curious if that IgM means it's some form of herpes virus, even if it's not HSV-1 or 2.     Thank you.
1174003 tn?1308160819
*sigh* At this point this is my last message on your thread.  You NEED to stop making this into herpes.  The IgM is worthless.  Completely WORTHLESS with HSV.  I have given you a link that discusses that in detail.

Time for you to move on and either accept your blood work or go get a "fever blister" or "cold sore" swabed for a culture.  At this point either way nothing else we can do for you here.  
1549643 tn?1495759353
Worthless to meaning anything, okay. LOL. That's what I wanted to know. Thanks.
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