Family doctor unsure of IgM results, suspects herpes

[cautiouslyoptimistic]

Hello,
Thanks in advance for your help. I’m very glad to find this forum and look forward to hearing your expertise.
I am a 31 year old heterosexual male. I have never had any symptoms of STDs or positive test results. During my early 20’s I was more sexually active than I am today, but I have been in several monogamous relationships over the last four years years and have been cautious who I sleep with (no one-night stands). In the last year, I have had sex with 2 women, both whom were in monogamous relationships. We used condoms sometimes (at first) or not at all in both cases.

I recently went to my doctor (a family practitioner) for a routine annual STD screen (no symptoms). My new girlfriend (who is an RN) and I just started having sex about a month ago. I asked my doctor to test me for “whatever he recommends.”

Almost a week later, his assistant calls and tells me I “have herpes type 2.” I was absolutely devastated, of course. I went to my doctor and he gave me these results. (full PDF attached WITHOUT personal info)

HSV1/2, Varicella IgG, IgM

Observations Result Reference

HSV 1 IgM SCREEN2 NEGATIVE

HSV 2 IgM SCREEN2 POSITIVE Abnormal (applies to non-numeric results)

Herpes simplex Virus Type 1 Specific Ab IgG1

Herpes simplex Virus 1 IgG Result1 Negative Negative

Herpes simplex virus Type 2 Specific Ab IgG1 <0.2 AI <=0.8AI

Herples simplex Virus 2 IgG Result 1 Negative Negative

Varicella Zoster Virus Antibody, IgM2 1.36 Above high normal

VARICELLA ZOSTER INDEX1 5.1 AI >=1.1 AI

Varicella zoster Antibody, IgG Positive Positive

RPR SCREEN W/REFLEX TO RPR TITER
RPR Screen1 Nonreactive Nonreactive

HERPES SIMPLEX 2 ANTIBODY IGM TITER (REFLEXED)
Observation Result Reference
Herpes Simplex 2 Antibody IgM Titer (Reflexed)2 1:20 Abnormal (applies to non-numeric results)

My doctor circled the “HSV 2 IgM SCREEN” result of “POSITIVE” and said this means I have been recently exposed to herpes type 2.

Then he got to the Varicella section and said he wasn’t exactly sure why those scores came out the way they did. He said it’s possible I could have false positives. He recommended I go see an infectious disease specialist for further testing.

I have been absolutely traumatized over the last week since getting these results. I’ve been doing my own research and have been finding credible articles and personal reports of these types of tests being false positives. I have also read that chicken pox, CMV, and HSV-1 can skew these kinds of test results.

For now, I have not yet seen the specialist and still have NO SYMPTOMS WHATSOEVER, nor have I ever. This is causing me incredible psychological distress and am hoping for some expertise.

My questions for you are:

1) How would you interpret these results?

2) What is the likelihood that my results are a false positive for genital herpes?

[Terri Warren]

I would interpret the results as you being uninfected with HSV 2. and also HSV 1. The IgM test is very unreliable and has many false positive and the Centers for Disease Control suggest not using it for the diagnosis of herpes. I personally have found it extremely unreliable and would never order it for any reason. I’m not sure why your doctor was was looking for evidence that you had chicken pox – most Americans do.

The test you want to pay attention to is the IgG test only.

Has your partner been tested?

[cautiouslyoptimistic]

Terri,

Thank you so much for your reply. I can’t tell you how much of a relief it is to find out the IgM test may be incorrect.

My girlfriend says she gets tested for STDs regularly and is all clear. She is a supervising RN at a nationally-known hospital here in our city, completing her MSN this year, so I am assuming she is being honest with me.

Now, it’s been a month since I first had intercourse with my girlfriend. I still have no symptoms whatsoever nor any reason to suspect I may have herpes other than this IgM test in question. What a traumatic thing this is; it’s wreaking havoc in my psyche and has just about killed our sex life due to the anxiety it has caused me.

My follow up question for you is:

I had the blood/urine for this STD screen taken about 2 weeks after my current monogamous girlfriend and I started having sex. Would that be enough time for the IgG test to be reliable, do you think? My doctor said those antibodies take much longer to produce.

[Terri Warren]

I had the blood/urine for this STD screen taken about 2 weeks after my current monogamous girlfriend and I started having sex. Would that be enough time for the IgG test to be reliable, do you think? My doctor said those antibodies take much longer to produce.

No, two weeks is not long enough, for sure. We suggest a final antibody test at 16 weeks, though most people who are going to make antibody will have done so by 12 weeks.
The fact that your partner is a nurse has little to do with this topic unless herpes is her specialty. I have had infectious disease doctors tell their patients the most erroneous information about herpes, just within the past month. I would just be certain that a type specific IgG herpes test was done as part of her STD screening package that was completed.

Terri

[cautiouslyoptimistic]

Thank you Terri. My final question:

Rather than waiting until 12-16 weeks from sexual contact and doing a final IgG antibody test, if I wanted to get a definitive answer as soon as possible for peace of mind, would a Western Blot test be a good alternative? I have heard they are very accurate.

Despite learning about how unreliable the IgM test is and not having any symptoms or any other reason to believe I have been infected, I am still paranoid and thinking “well what if the IgM test was right…” Additionally my girlfriend and I are breaking up so it may be harder to ask her questions about her last STD screen, which is why I am wondering about the Western Blot.

[Terri Warren]

NO. A western blot is a poor screening test for possible new infection as it takes longer to become positive than the IgG screening test.

Shame on your provider for doing this test. The CDC strongly recommends against doing it and if I were you, I would call them on it. It is so hard to get people to believe they are infected after a positive IGM, even in the face of multiple IgG tests that are negative. I’m afraid you will just have to wait the time to get the accurate answer. I wish there was more that I could do for you. I understand that waiting is difficult.

This was our final post on this subscription. If you have more questions, feel free to renew..

Terri

[cautiouslyoptimistic]

Terri,

Thanks so much for your help. I can’t tell you how helpful it is to be able to ask these kinds of questions to someone who is an expert on this topic. I have purchased additional follow up questions, because there are a few more I’d like to ask.

On my lab results the HSV2 IgM result is simply listed as “POSITIVE” but there is no score given. From what I have been reading it sounds like the lower the score, the higher the chance it was a false positive. I am not sure if that is correct or not, and from what I am learning it sounds like the IgM test is so unreliable the score may not even matter.

Would getting my HSV2 IgM numeric score from the place that did the test provide any idea of the likelihood that the test was accurate/inaccurate? Or is it an unreliable enough test that the score doesn’t really make a difference?

I am wondering because if it is very low, that may help provide me a little more peace of mind.

[cautiouslyoptimistic]

Terri,

Two more questions tonight as I am reading and contemplating things.

1. I’d like to see if my IgG levels have risen at all in 5 weeks. If not, perhaps I can get some peace of mind that my IgM test is likely to be a false positive. I understand that it may take more than 5 weeks for IgG antibodies to appear but I need to get more concrete data to work with. Can I order an IgG test through your clinic and what is the cost?

2. In your experience do you have any sense of the female-to-male transmission rates? If in fact my ex girlfriend has HSV-2, we had intercourse four times so I am trying to establish some kind of statistical inference about likelihood of transmission, purely for my own understanding.

Thank you. This has been extraordinarily traumatic and these answers are very helpful.

[cautiouslyoptimistic]

One more detail: I purchased additional follow up questions. Hopefully it shows up automatically.

[Terri Warren]

1. I’d like to see if my IgG levels have risen at all in 5 weeks. If not, perhaps I can get some peace of mind that my IgM test is likely to be a false positive. I understand that it may take more than 5 weeks for IgG antibodies to appear but I need to get more concrete data to work with. Can I order an IgG test through your clinic and what is the cost?

You can, but it would probably be cheaper to order it through any online STD testing service. There are many on the internet and remember that you want only IgG, no IgM. Through our clinic, it would cost about $100, and I’m sure you can do it more cheaply on the internet.

2. In your experience do you have any sense of the female-to-male transmission rates? If in fact my ex girlfriend has HSV-2, we had intercourse four times so I am trying to establish some kind of statistical inference about likelihood of transmission, purely for my own understanding.

Did you use condoms when you had sex with her? Was she on daily suppressive therapy?

Terri

[cautiouslyoptimistic]

Hi Terri,

No we did not use condoms. She was not on daily suppressive therapy and had no symptoms as far as I noticed.

[Terri Warren]

The risk of getting hSV 2 is not great but not zero. The risk having sex twice a week for a year with no suppression and no condoms is about 4% (4 men out of 100 would get infected in a year). So you can figure out the risk with four total intercourses, yes?

Terri

[cautiouslyoptimistic]

Terri,

That is very hopeful to hear. Thank you so much for your expertise. Of course I will still be getting 2-3 IgG tests done over the next few months just to be sure, and not having intercourse in the mean time. But I’m so glad to hear those statistics.

[Terri Warren]

Good!

Terri

[cautiouslyoptimistic]

Terri,

I purchased an additional round of questions.

I’m attaching a photo. Can you tell me if these look like herpes? These are some bumps I noticed about a month ago on the underside of my penis shaft. Don’t know how long they’ve been there. Didn’t think anything of them at the time, thought they were just hair follicles or something. Since having the positive IgM it just occurred to me that I should find out if these are herpes or not. I googled lots of photos of molluscum, herpes, warts, fordyce spots, etc. and don’t know what to think.

They don’t itch and aren’t painful at all. Are you able to tell if they look like herpes or not?

Thanks

• This reply was modified 8 years, 3 months ago by cautiouslyoptimistic.

[Terri Warren]

These really don’t look like herpes to me but it isn’t easy to visualize, though I see the bumps. If they have been there a month and haven’t changed, they are very unlikely to be herpetic.

I’m so sorry this IgM test has you thrown off . I’m so bummed that it was ordered. Sometimes it takes months and months for people who get this result but a negative IgG to believe that they are not infected. I

Terri

[cautiouslyoptimistic]

Hi Terri,

Thanks so much for your work. I can tell you are a genuinely caring person who is really trying to make a difference.

Good news. I had an IgG test drawn on Friday which came back negative for HSV2. So to summarize, here are the facts:

• 1 Week from last possible exposure: Blood drawn for routine STD screen at family doctor. Showed HSV2 IgM POSITIVE (no index value), HSV2 IgG NEGATIVE <0.2 AI

• 5 Weeks from last possible exposure: HSV2 Type-2 Specific Ab, IgG Result: NEGATIVE <0.91
o No exact value given on result sheet. Ordered this test myself from Requestatest.com which is why the result scoring is different than the first IgG my doctor ordered).

• Still no symptoms at all. Went to Planned Parenthood and had three very small bumps examined on shaft of penis by the clinician. Was told they are normal raised skin and not related to any STD. Have been there for 2 months or longer. Would have never thought anything of them if not for the positive IgM.

• Only 1 partner inside of seroconversion window (16 weeks) of first negative IgG on 5/21 and second IgG on 6/19.
o We had intercourse only four times, did not use condoms
o Says she tested negative 6 months ago (did not have specific blood test information)

• No reason to suspect I have been infected other than the original positive IgM test result as part of routine STD screen
done on 5/21 by my family doctor. This positive IgM has caused me so much anxiety and depression over the last month.

Based on the female-to-male transmission rate of 4% over a year of intercourse, on only four total intercourses (even if my last partner DID have HSV2) my risk of infection would be well under 1%.

I understand that the IgG seroconversion window could be as long as 12-16 weeks but I am trying to get some peace of mind in the mean time. In light of the negative IgG test I just had drawn 5 weeks from last possible exposure, and based on the data and facts above, what do you think my risk of infection might be?

[Terri Warren]

I think you’ve got all the facts correct here and the chances are very good that you are truly negative.

Terri

[cautiouslyoptimistic]

Terri,

Thank you so much. This whole time most of my anxiety comes from the idea that a positive IgM could indicate a “recent” infection as explained by my family doctor but that it won’t show up on an IgG test until August or September (based on last possible exposure).

However, I just read in your Herpes Handbook that with herpes, IgM and IgG antibodies occur at about the same time; IgM does not occur earlier with herpes as it does with other viruses.

If so, since I have had 2x negative IgG’s now then it would seem there is a strong possibility that I may be able to ignore the IgM because it contradicts both of the IgG’s. If (a) IgM occurs at the same time as IgG and (b) my positive IgM was accurate at all, then shouldn’t one or both of my IgG’s have been positive or at least indeterminate? (both are negative)

I realize everyone who is sexually active has some inherent risk of infection unless they are in a monogamous relationship. I accept that. No one is ever really “0%” risk so that’s not what I am after here. I am just trying to figure out if I can reasonably eliminate this positive IgM as suggesting I was RECENTLY infected but that it may not show up on an IgG test until August or September.

Can you confirm, for my sake, that this is in fact proven and true: IgM does not appear early with herpes? Is there a study I can read that showed that perhaps? That would be a big help.

Perhaps I should purchase and schedule a phone consultation instead of posting in this thread. Let me know if you recommend that instead.

[Terri Warren]

I think we need to clarify about the IgM test and the function of the IgM antibody. IgM can come up first with new infection, but it an also come up with recurrences and with an IgG and it can be positive falsely, which in my experience, is the most common. I do not feel like you are out of the woods. You’ve had two negative IgG tests but the timing is not perfect. You can certainly do more IgG testing while you wait for the 16 weeks to go by and the more negatives you have, as time goes by, the less likely you are to be infected. I know you want me to say that the IgM is never correct but I can’t say that because I don’t know that to be true. This likely makes you more uncomfortable but my job here is not to make you comfortable but to give you accurate facts. I would be happy to talk with you on a phone consultation, of course.

You have 11 posts here and have paid for 9. If you have more questions, please renew and it would be really good if you paid for the extra two posts at this time.

Terri

• This reply was modified 8 years, 3 months ago by Terri Warren.

[cautiouslyoptimistic]

Hi Terri,

Thank you for your candor. I purchased an additional round of questions so I should be caught up now – I must have lost count. My apologies.

Would there be any value in going to see an infectious disease specialist – are there any other tests they might be able to run while I wait until August to do a final IgG test? It doesn’t sound like there is but want to make sure I am looking into every option to figure out if the IgM test my family doctor gave me is right/wrong.

[Terri Warren]

NO. And I worry that that might complicate things by them doing another IgM test – even ID docs don’t seem to know much about proper testing for herpes. I know this is frustrating for you but nothing will take the place of time here. I think just continuing to test as you go along will be the most reassuring.

Terri

[cautiouslyoptimistic]

Terri,

I renewed my subscription. I apologize for asking so many questions. I can’t seem to get the positive IgM out of my mind. Still have no symptoms (had those bumps examined and was told they’re not an STD, also they are still there and have been for at least 2 months now) or any other reason to suspect I have HSV2 other than the IgM test.

My question: I was reading through some other threads, and thought I read you saying something about how you don’t usually see someone with a positive IgM and negative IgG go on to develop a positive IgG later on. Did I read that correctly?

• This reply was modified 8 years, 3 months ago by cautiouslyoptimistic.

[Terri Warren]

You absolutely did see that correctly. Of course I don’t always hear about follow up IgG tests, but so far, I don’t recall having someone present to me with a positive IgM, and negative IgG that has gone on to have a positive IgG antibody test.

Terri

[cautiouslyoptimistic]

Terri,

Wow, that is a powerful insight. Sounds like the IgM (by itself) is nearly worthless. Still, I just can’t seem to get it out of my head, even though I have no other reason to think I have been infected. It’s created a paranoia in me; almost like I’ve become a herpes hypochondriac.

I am planning to get another IgG test next week, which will be 8 weeks from last possible exposure. Can you tell me what percentage of the population would seroconvert by 8 weeks? I know I’ve read in other threads that 70% would convert by 6 weeks so I am wondering what 8 weeks might be.

I can’t tell you how grateful I am to have someone with your expertise and experience available as a resource. You’ve been a great help to me so far.

• This reply was modified 8 years, 3 months ago by cautiouslyoptimistic.

[Terri Warren]

I don’t have a number for eight weeks, sorry about that, only for 6 weeks and 16 weeks. So it’s more than 6 weeks which is 70% but less than 100%. That DAMN IgM, I can’t tell you how much trouble it has caused people over the years. So troubling. Sorry this happened to you.

Terri

[cautiouslyoptimistic]

Terri,

Good update to share. Back in July my 8-week IgG for HSV2 was negative (<0.91). Now I’m at almost 14 weeks since last possible exposure. Still have not developed any symptoms as far as I can tell and no reason to think I have been infected except the positive IgM back in May that my primary care doctor ordered with my routine STD screen.

I am still dealing with a fair amount of anxiety over the IgM. I keep thinking “what if it was right and I just don’t have any symptoms….” I’ve struggled with anxiety disorders earlier in life (in my early 20’s) so it’s very possible I am over thinking things more than I should due to my anxiety-prone personality.

What do you think my chances are of being infected with HSV2? If I do a final IgG test this week at 14 weeks how reliable would that be? If I wait a few more weeks to 16 weeks how reliable would that be?

Thank you for your help!

[Terri Warren]

If your screening test is negative at 14 weeks, I would recommend that you settle for that as a real negative.

Terri

[cautiouslyoptimistic]

Terri,

I renewed my membership just to share with you that my 14 week IGG test came back NEGATIVE today. I am so thrilled and relieved.

It’s hard for me to express how grateful I am to you for your work. Without your guidance, who knows what I would be thinking today and what kind of misinformation I may have believed from doctors without the expertise in this area that you have. Your answers and clarity were a shining beacon of expertise through this very challenging and emotionally tortuous ordeal.

THANK YOU. You have, quite literally, changed my life.

[Terri Warren]

I’m very pleased for you! I know this has been a real struggle for you. And I’m glad that the forum has been helpful for you, it does seem to meet a need.

Terri

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