I had unprotected sex with a male friend on 4/16/05. The intercourse part only lasted a minute. I developed a strange bump 2 weeks later which my gyno said was a molluscum. I went to my derm for another opinion and he agreed and froze it. About a month later I noticed another one and my derm said it might be another one and froze it. Because of this happening to me I was scared thinking what else he could have given me. My friend was adamant that he didn
I'll try to help. First, your symptoms don't sound much like herpes; on that account, I would suspect you're not infected.
Second, however, I am confused by the test results you describe. The HerpeSelect result showing HSV-2 EIA ratio of 2.36 is definitely positive, indicating HSV-2 infection. But you say the repeat test of 0.15 is "still negative". Are those result right, or is there a typographical error? If you got the results right, I have to be suspicious of a lab error, or that your specimen was mixed up with someone else's test; the two results are not compatible with one another.
IgM antibody tests for HSV infection are WORTHLESS. Tell your doc I said so; he shouldn't have ordered the test, and labs that continue to offer IgM herpes test should be strangled. The result is meaningless. (Yes, I feel a little evangelistic about this.) You can completely ignore those results; it was a waste of money (yours or your medical insurance) to do that test.
On to your specific questions:
1) No, your doctor is not right to insist you have HSV-2 based on the IgM result. However, if he is basing that on the HSV-2 result of 2.36, he has a case. See above.
2) As I said above, forget the IgM result. It is meaningless. (Your doc undoubtedly is well meaning, and for many infections a positive IgM test means recent infection. But it doesn't work that way with HSV-2.)
3) I can't tell whether you have herpes, because of the discrepant HerpeSelect results. Unless you made a mistake in the numbers, you should have a repeat test to figure out the truth. Focus Technologies, the manufacturer of HerpeSelect test, will probably do special testing at not cost, if you have another specimen sent and your doctor explains the situation, i.e. the opposite results of the two tests.
Oops--sorry! The way your comment was written, I thought you said your first HSV-2 test had an EIA ratio of 2.36. I think you meant 0.36. Apologies! If that's correct, you can be confident you do not have HSV-2.
That said, your test was a bit too early to be entirel sure. To be safe, you should have another HerpeSelect HSV-2 test around 3 months (12 weeks) after your last possible exposure. If it is negative, you can definitely be certain you don't have HSV-2.
i haven't seen this aspect discussed anywhere.
can anyone, or would anyone care to comment on the cost of herpes select tests? i have no insurance and was tested by my gyn. for I&II and also a vaginal smear to test for an active virus or outbreak. the lab invoice came back at just over $500.
i was surprised. this seemed very high. can anyone comment? i would guess that a clinic would have been less expensive.
I had the same result on my IgM test six weeks after exposure. My doctor also told me that there was a good chance I had hsv and to retest in two weeks. She said if the IgM results got higher then I could be sure I had hsv and if the IgM results go down then my IgGs should be positive or equivocal (according to her there is a crossover between IgMs and IgGs.) When I retested in two weeks everything came out negative. So yeah as the doc said IgM tests are stupid. It caused me a lot of unnecessary worries.
I believe HerpeSelect usually is $20-50, but varies widely. A herpes culture typically is $50-100, I believe--but it's also all over the map. My guess is your very high cost included more than just herpes testing.
The public health lab in Seattle charges $25 for HerpeSelect HSV-1 and -2 together, or $15.00 if only one of the tests is done. The lab does not lose money; those are the break-even costs considering purchase of the test kits, personnel time, delivery of results, etc. Most commercial labs charge more, but I don't know whether the healthcheckusa.com price is below, at, or above average. The break-even price for any particular lab is volume-dependent; the more tests done, the lower the cost per test.
Very few labs offer it at that price unfortunately!! That's part of the reason why very few planned parenthood clinics even offer herpes blood testing - they don't have a lab that will perform it that cheaply for them.
The herpes select igg for hsv1 and hsv2 will run you around $100 if you order it yourself thru healthcheckusa.com. It's usually around $80-$100 or more in most doctor's offices. You can get it cheaper some places but not many. The lesion culture will also run you about the same amount of money. Throw in a doctor's office visit fee and yes indeed you've just plunked down several hundred dollars for testing.
To the person with the $500 bill - sometimes if you call and ask ( ok beg - tell a tale of woe ) they can sometimes reduce your bill a bit when you are paying out of pocket. Never hurts to ask.
Doc, thanks for your reponse and for realizing you misread my results. You are correct the HSV2 result using the herpeselect test at 9.5 weeks was .36 not 2.36. I should have put a space between the HSV2 and the .36. You said to be sure I should retest at 3 months. I did retest at month 4 and the result was EIA for HSV2 .15 and EIA for HSV1 .20 . I think I can feel safe I don't have herpes despite the fact the my gyno said I was taking the retest too early. I'm glad you said the positive IgM is useless in indicating that a person has something. I have seen you say before that it is useless in telling when a person got herpes. I was nervous thinking that since my result on the IGG was negative that meant that sooner or later it would be positive. That is exactly what my doc beleives. Thanks again and thanks for the wonderful serivce you do for all of us.
With those results, you can be confident you don't have HSV-1 or -2. In theory, there is a very slim chance you could still develop a positive result; once in a while it takes up to 6 months. But that is extremely unlikely, and your "borderline" IgM result is meaningless. Here is why, written in a way that you can consider printing out and giving to your doctor (if s/he is the sort who appreciates being updated with new information and not resentful if it comes from a patient). I'm also doing it so there will be a place on the STD forum where I can refer future questions about IgM HSV testing.
Your doctor was trained, as we all were, that the immune system first produces IgM antibodies in response to most infections, that IgG antibodies develop later, and IgM antibodies then fade away. Thus, an IgM response indicates recent infection. But the principles don't apply equally to all infections. Measurable IgM antibody sometimes doesn't appear at all in HSV infections, and in other cases, IgM does appear when HSV recurs; thus, absence of IgM doesn't mean the infection is chronic, and presence doesn't relably indicate early infection.
But there is another, even more important problem: The reliable, type-specific tests for HSV detect antibody against an HSV antigen called glycoprotein G (gG) (confusingly, this is entirely different than IgG). HerpeSelect is an IgG test for antibody to gG1 and gG2, indicating HSV-1 and -2 infections, respectively. But there are no IgM tests that detect antibody to gG1 of gG2; such tests simply do not exist. Thus, any HSV test for IgM antibody is looking at nonspecific antibody by such technologies as complement-fixation, indirect fluorescent antibody, and other methods. These our outdated technologies for measuring HSV antibody, and it is now known that they simply are not accurate reflections of the body's response to HSV.
In other words, every time someone posts a result on this forum that gives an IgM result for herpes antibody, it is direct evidence that the test result in unreliable; it means an old-fashioned, outdated test method was used. There is no indication for IgM HSV antibody testing in routine clinical practice.
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