Use of IGM to determine length of time since exposure?

[upended]

I have a history of cystic acne, and about 3 weeks ago, I had 2 cysts develop on my inner labia.  I typically tended to develop these cysts on my inner thighs or outer labia, but this is the first time that they'd ever been inside my labia.  That fact, combined with the fact that I'd had a new partner in mid-December, pushed my paranoid button and I decided to see my ob/gyn just to make sure that they cysts weren't herpes.  

My doctor assured me that the cysts were not herpes, but decided to order bloodwork to test for herpes just as a peace of mind precaution.  She also prescribed a course of Cipro for the cysts, which seemed to work...they subsided almost immediately, never having come to a head or developed into any sort of open sore.

However.  My "peace of mind" bloodwork came back positive for HSV-2.  The lab tested for both IGG (using the Focus HerpeSelect test...I called the lab and double-checked this specifically after reading the info here) and IGM.  Results are as follows:

HSV-1 IGG  0.50
HSV-2 IGG  1.52

IGM - negative

My doctor's office is trying to tell me that the negative IGM indicates that the exposure isn't recent (i.e. is probably not from my most recent sexual encounter in mid-December).  Can this be true?  From what I've read here, it seems like current opinion is thath IGM has no diagnostic value for HSV at all.  If so, why is my doctor's office basing their current vs. prior infection conclusion on it?

Also...I know this is probably my total shell-shocked denial kicking in, but is there any chance that this result is wrong?  Is there any merit in being retested based on the above results?  Considering my doctor *still* doesn't think that the cysts that prompted me being tested to begin with were a herpes outbreak, I have never had any symptoms of HSV whatsoever.  And, if the conclusion that my exposure is older than a year is correct, then the last possible exposure that I had was almost 4 years ago.  Is it possible to have HSV-2 for 4+ years and never have a single symptom?  And if it's not reasonable to conclude that my exposure was a year or more ago, is it possible that my exposure was during my mid-December encounter, and if so, shouldn't the IGM be positive?

I'm so very confused and upset right now.  

[H. Hunter Handsfield, M.D.]

Your HSV-2 infection isn't necessarily related to the cystic acne lesions in the genital area; and yes, it is entirely possible to have HSV-2 for 4+ years and have no symptoms.  Your HSV-2 ELISA ratio of 1.52 probably is positive, but it is lower than average in most infected persons.  If you have not been paticularly at risk, and in the absence of typical herpes symptoms, you might ask your doctor about doing a confirmatory test, such as a Western blot.  (Not to get your hopes up--the result probably is valid, but this would clinch it.)

Finally, see many other threads on this forum about HSV IgM testing.  For many infections, IgM antibody indicates recent infection and its absence suggests distant infection, but despite the beliefs of many doctors (if they are not herpes experts), it doesn't work that way with HSV.  Your negative IgM result makes it slightly more likely your infection is older than 6 months, but by no means definite.  (Search the threads for "herpes diagnosis" and "IgM".)

Good luck--  HHH, MD

[virgogrl]

Hi, I'm sorry you are having to go through this, it really sucks.  I was recently diagnosed and have no idea when I got it.  A friend of mine went for a normal gynecological visit and found out she had it, she hasn't had sex in over 5 yrs!  I also have a male friend who says he got it even though he wore a condom.  I think this virus is incredibly easily spread and I read a statistic that 90% of people who have it don't know they have it therefore your chances of getting it are extremely high.  

There are some people who experience painful outbreaks but for most people it seems to be more of an inconvenience than anything else.  Please don't think your life is ruined or get severely depressed over this.  Maybe I am downplaying it too much but it's not that big of a deal, it just has a horrible stigma attached to it.  It's cold sores just on a different part of the body, don't forget that!

[t1234]

My view is that it never hurts to be retested for
comfirmation just to be sure.  If the number for the
IGG HSV2 Antibody is 3 or less, I would use a Western
Blot.

IGM doesn't mean much or has no predictive value.
I've been falsely diagnosed as having herpes by a
"lab tech" at an STD clinic only to find out six
months later I didn't have it on two occassions.

There's a lot of misinformation and hype about herpes.

Your current partner needs to be tested to find out
his status, but even if he's positive it doesn't mean
you got it from him. There's just no way of knowing.

If he is positive, it's no "big deal".  If he's negative
then consistent use of condoms, and supressive antiviral therapy
will probably prevent him from getting it (no guarantees).

[upended]

Thank you, Dr. H.  I'm making an appointment with my GP to talk about additional confirmation testing, since I no longer have much confidence in my OB/GYN's expertise in this area due to the misinformation on the IGM significance.

Unfortunately, I'm no longer seeing the guy I was with in December, which makes this all that much more awkward if the retesting confirms the positive result.

[nsns]

You should contact the guy and at least let him know, everyone including myself who is positive with HSV2 has a responcibility to stop the spreading of it. It really is not a big deal, it sucks to have it but life goes on! I always thank god that I did not get HIV. By the way I was in an 8 year long relationship and I told my girlfried about my HSV when we first started dating and she decided to not want me to ware a condom after the first month and after 8 years and 100's of times haveing none protected sex she still tests neg. And I get at least 10 outbreaks a year.. So like I said life goes on and anyone who will not acept you with hepes is probibly someone you don't want to be with anyway!

[gracefromHHP]

Don't be so hard on your gyn - most doctor's just base their understanding of herpes igm testing on igm testing for other infections - they haven't had any additional/recent herpes testing training to know how to better read the tests :) You might want to print out one of Dr H's excellent igm posts here and share it with your gyn or print out some of the info from www.herpesdiagnosis.com to share so he/she can learn from all this :)

there is a doctor's list at www.westoverheights.com you might want to check to see if there is a doctor on it near you. They are medical practioners who have been thru Terri Warren's extensive herpes lectures and who hopefully have a decent understanding of herpes, testing and treatments. Also the herpes handbook is there too - it's a terrific resource to learn more about herpes from :)

You can contact your last partner and ask him to get a type specific herpes igg blood test and share a copy of the results with you. If he is hsv2- then you know you've had hsv2 for far longer than you suspect.  If he comes up hsv2+ and starts to accuse you of transmitting it to him - you have the option of getting a herpes avidity blood test from the U of washington as long as it's been less than 4 months since your sexual encounter with the fellow.  It can tell if your herpes infection is newer than 4 months or older than that ( not a specific date but helps to narrow down if it is indeed a new infection for you or not ). Just something to think about for peace of mind.

grace