IgG accuracy / IgM question

[stressmachine5000]

Hi Terri,

September 1: I (female) had unprotected sex with two other women, one had swab confirmed GHSV1 5 years ago. Her second outbreak was when she got Covid this year in May. They have occasional casual sex with others together, but her partner of 3 years tested seronegative for both HSV1&2 this summer. Heavy kissing over a week but low sexual contact, mostly manual stimulation, no direct genital contact. One instance of fluid transfer (the same fingers inside of me immediately after being inside of the partner with GHSV1), but no outbreak at the time. I recovered from Salmonella a couple days before this, so I imagine my immune system was weak.

September 15: I start seeing my current partner (female).

September 19: I have full-body hives for 3 days. No other viral symptoms such as headache, fever, etc.

October 7: Full STI panel. Also a mild fever, a sore throat and headache which lasts a few days. All other STI results negative except herpes IgM:

October 7 (4-weeks post exposure):

HSV 1-2 combined IgG: <0.5
HSV 1-2 combined IgM: 3.4

October 24: PCR swab of a butt pimple. Negative.

November 2:

HSV1 IgG: <0.5
HSV2 IgG: <0.5
HSV1 IgM: 0.91
HSV2 IgM: 0.55

November 9: Another headache/sore throat/congestion.

November 15 (11 weeks):

HSV1 IgG: <0.5
HSV2 IgG: <0.5
HSV1 IgM: 0.71
HSV2 IgM: 0.54

All tests are CLIA and done in Spain.

My current partner tested IgG and IgM negative 4 weeks into our relationship.

At 11 weeks and my level of exposure, I feel confident I don’t have HSV2.

My concern is HSV1. I’ve had no obvious “blisters”, but get lots of acne. Lip-line pimples are not new, so it’s hard to say, but every lip-line pimple I’ve had has popped and squeezed out white like a pimple.

1. I know IgM is bad, but I haven’t seen an IgM as high as mine. A 3.4 followed by a steady decrease to equivocal, then to negative over 2 months seems consistent with a new infection, especially given the exposure time. Would you still consider that obsolete?

[stressmachine5000]

Next questions:

2. I’m curious about the 30% false negative with HSV1. Low positive index values are a significant predictor of discordant results between Elisa and WB. Does the same concept apply to high negatives with an HSV1 test? In other words, assuming all other factors (lab, timing, lack of symptoms, etc) were the same, would you expect a person with an HSV1 IGG of 0.1 to share the same 30% chance of a false negative as someone with an HSV1 IGG of 0.7?

3. We are in Europe. The WB is out of price-range, and doesn’t seem reasonable in my case. But, I do still worry about that 30% false-neg for HSV1. After 3 months of stress, I don’t want to give her GHSV1 thanks to a false test. Would you feel confident in a negative result if we both tested negative after 3 months with each other? Especially as my most likely time of transmission has already passed and we weren’t using protection?

4. HSV2 increases your risk for HIV. Is the same true with GHSV1?

5. Your research was compared to American ESLIA tests, whereas in Spain we are using CLIA. Though similar in procedure, the research that I have found suggests that CLIA is be more sensitive. Do you have any knowledge of this?

6. My doctor seemed to believe that the IgM was likely a false pos caused by the full body rash (urticaria) three weeks prior. I have had full body hives before due to allergy, though in this instance there was no obvious allergen to explain it. This rash did not cause any ulceration, the only lasting effect was constant peeling of the fingertips for 2 to 3 weeks afterwards. Very strange.
Have you seen IgM positives be skewed by other factors such as this? More importantly, in all your years have you ever seen anyone whose first symptom (or any symptom) of HSV be full body hives?

Thank you, Thank you, Thank you, from me and all of us!

[Terri Warren]

1. I know IgM is bad, but I haven’t seen an IgM as high as mine. A 3.4 followed by a steady decrease to equivocal, then to negative over 2 months seems consistent with a new infection, especially given the exposure time. Would you still consider that obsolete?

I have seen IgM as high as yours and they are almost always false positives which is indicated by a follow up negative IgG.

2. I’m curious about the 30% false negative with HSV1. Low positive index values are a significant predictor of discordant results between Elisa and WB. Does the same concept apply to high negatives with an HSV1 test? In other words, assuming all other factors (lab, timing, lack of symptoms, etc) were the same, would you expect a person with an HSV1 IGG of 0.1 to share the same 30% chance of a false negative as someone with an HSV1 IGG of 0.7?

We know less about the IgG for HSV 1 and its predictive value for a true positive. I would say, from anecdotal experience, that higher negatives do present a bit more of a risk of being false negatives than low negatives, yes.

3. We are in Europe. The WB is out of price-range, and doesn’t seem reasonable in my case. But, I do still worry about that 30% false-neg for HSV1. After 3 months of stress, I don’t want to give her GHSV1 thanks to a false test. Would you feel confident in a negative result if we both tested negative after 3 months with each other? Especially as my most likely time of transmission has already passed and we weren’t using protection?

I honestly can’t say. With a test that misses 1/3 of infections, I’m not clear how to guide people who get a negative. I would say if you have no symptoms and you think you might have genital HSV 1, the risk is already low because HSV 1 genital infection is rarely transmitted through intercourse.

4. HSV2 increases your risk for HIV. Is the same true with GHSV1?
NO, because genital HSV 1 is rarely active.

5. Your research was compared to American ESLIA tests, whereas in Spain we are using CLIA. Though similar in procedure, the research that I have found suggests that CLIA is be more sensitive. Do you have any knowledge of this?

We also use CLIA based testing. I don’t see a difference between the routine ELISA and the newer CLIA tests in terms of sensitivity for HSV 1.

6. My doctor seemed to believe that the IgM was likely a false pos caused by the full body rash (urticaria) three weeks prior. I have had full body hives before due to allergy, though in this instance there was no obvious allergen to explain it. This rash did not cause any ulceration, the only lasting effect was constant peeling of the fingertips for 2 to 3 weeks afterwards. Very strange.
Have you seen IgM positives be skewed by other factors such as this? More importantly, in all your years have you ever seen anyone whose first symptom (or any symptom) of HSV be full body hives?
nope

Terri

[stressmachine5000]

Hi Terri, thanks for your replies, this is my final post unless I decide WB. Update:

(Eurofins megalab, hsv1/2 combined):
5 weeks post exp: IgG <0.5, IgM 3.4
12 weeks post exp: IgG <0.5, IgM 2.8

(Synlab taken 1 day after eurofins megalab 12 wk for lab comparison):
Hsv 1: IgG <0.5, IgM 0.9
Hsv 2: IgG <0.5, IgM 0.56

1. I have been sick with some type of cold/flu the entire last two months. Could that have slowed down my IgG immune response to HSV? (Full blood work w/ first test showed no abnormal blood cell counts or infection markers)

2. I had an ingrown swabbed, pcr negative. Had a couple of small pink bumps inside the vagina visually diagnosed as hsv, PCR swabbed negative (very diligent swab including scalple scratch that didnt really hurt). Was told to accept I had it based on visual and IgM, regardless of the negative PCR/IgG.

3. Only other symptoms have been occasional pain/burn/prickling in my left labia, and some strange white spots (indented, smooth, not blistered) which look like scars with no hair and then turned into a distinct wrinkle, labia majora. I have also seen a couple of red lines on the labia that I cant distinguish from being a tiny cut, vein, or crease redness from natural skin folds. When you see cuts with herpes, are they normally quite noticable and obviously a cut? I only see tiny pink lines with a 10x mirror and flashlight when pulling the skin quite taunt, and nothing has scabbed/bled/leaked.

4. If someone fingered a woman with no active outbreak and then fingered me immediately after with the same finger, would that be a reasonable risk? (GHSV1 only to their knowledge, and they have clearly identified 2 OBs in the past). That is my only possible exposure for genital HSV.

5. As for the WB, I will only be in the USA for Christmas, from 12/17 to 1/7 and have no insurance. If I arrange with you do I also need a doctor to fill out the order? Any idea how much shipping generally is from the Southeast? I would go through AnyLabTestNow.

[Terri Warren]

1. I have been sick with some type of cold/flu the entire last two months. Could that have slowed down my IgG immune response to HSV? (Full blood work w/ first test showed no abnormal blood cell counts or infection markers)
No, I don’t believe so

2. I had an ingrown swabbed, pcr negative. Had a couple of small pink bumps inside the vagina visually diagnosed as hsv, PCR swabbed negative (very diligent swab including scalple scratch that didnt really hurt). Was told to accept I had it based on visual and IgM, regardless of the negative PCR/IgG.
that’s terrible. I would strongly disagree. The IgG and PCR should be the deciding factors, though the western blot is a better igG test-type – it’s really not just an IgG.

3. Only other symptoms have been occasional pain/burn/prickling in my left labia, and some strange white spots (indented, smooth, not blistered) which look like scars with no hair and then turned into a distinct wrinkle, labia majora. I have also seen a couple of red lines on the labia that I cant distinguish from being a tiny cut, vein, or crease redness from natural skin folds. When you see cuts with herpes, are they normally quite noticable and obviously a cut? I only see tiny pink lines with a 10x mirror and flashlight when pulling the skin quite taunt, and nothing has scabbed/bled/leaked.
that doesnt’ sound herpetic

4. If someone fingered a woman with no active outbreak and then fingered me immediately after with the same finger, would that be a reasonable risk? (GHSV1 only to their knowledge, and they have clearly identified 2 OBs in the past). That is my only possible exposure for genital HSV.
OMG, that is such a low risk

5. As for the WB, I will only be in the USA for Christmas, from 12/17 to 1/7 and have no insurance. If I arrange with you do I also need a doctor to fill out the order? Any idea how much shipping generally is from the Southeast? I would go through AnyLabTestNow.

We will fill out the order, but you’ll need the kit shipped to somewhere in the SE. You could talk to the anylabtestnow about receiving it if you don’t have someone who can. 2nd day air shipping is probably about $50

If you want me to be the ordering provider, we’ll need to have a video conference first.

Terri

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