Positive IgM test

[Concerned Mom]

My son just started his freshman year in college and 3 weeks after school began he became very ill. It started with sore throat, fever, chills, and fatigue. About a week after those symptoms started he developed what looked like puss pockets throughout his mouth and the back of his throat. He went to the campus doctor, they assumed he had strep throat and gave him a ZPak. He came home the following weekend, had finished his medication and was still running a fever over 101. I took him to urgent care and they tested him for strep and mono, both were negative but they gave him more antibiotics. A couple of days later he was not feeling any better so I took him back and they gave him an antibiotic shot and a steroid shot and he went back to school. At this point they assumed he had mono because the test level was higher than normal, but was not at the level that states it mono. I don’t recall what the test was called, but for it to be mono it should be 20 and he was at 15. He went back to school and came home again the following weekend and at this point he had two massive puss pockets in the back of his throat near his tonsils. I took him to the ER worried that it was a tonsil abscess, they tested him for strep and mono again and it was negative. The ER doctor advised that he thought it was mono and released him.

Unbeknownst to me, my son returned to the urgent care doctor and asked to be tested for herpes. At that point they prescribed him Valtrex and he started taking it. After 5 days of taking it his throat is pretty much clear. The results have since come back and we were told that he tested positive for HSV 1 and HSV 2. This is only oral, he does not have any sores below his waist. The test they used is the IgM test.
I have read several of your forums and some of the handbook and noticed that the IgM test is not recommended. What test do you recommend? From what I have gathered it is not typical for someone to contact HSV 2 orally only. He does not have any health problems and he had a one-time encounter. Additionally, he does not have any sores below the waist. I guess I’m confused as to what a positive IgM test means as far as the antibodies. From what I’ve read I believe that those antibodies could be present for HSV 1, 2 or even chicken pox or mono.

[Terri Warren]

We recommend the IgG antibody test – it is far far more reliable than the IgM. How awful that they used that test and told him had had HSV 1 and HSV 2 – he must have been terrified. Even the CDC says never use IgM testing to diagnose herpes. Do you know if he was the giver of oral sex to the person with whom he had the one time sexual encounter or was it just intercourse?

And I might add, just because his throat is clearing on Valtrex doesn’t mean that he is clearing because he has herpes. He could just now be responding to the antibiotics and the timing is coincidental. hard to know at this point. Do you know if any of the lesions he had in the throat were swab tested for herpes? Did he ever had sores on the lips?

Terri

[Concerned Mom]

Thank you for your timely response. Unfortunately this diagnosis has traumatized him and he has become depressed. Honestly I was concerned for him to return to school but he cannot afford to miss any more classes. This is the reason I have a sense of urgency to clear this up. If he has it, then I think he needs to know for sure so he can begin to deal with it emotionally and move on. This is his first semester in college, and I am afraid of the affect it will have on his academics as well. I believe this may have been his first sexual encounter, so as you can imagine for this to occur as a result is very upsetting for him.
In defense of the doctor, he apologized for not testing for this sooner. We discussed how my son had seen three different doctors and not one ever suggested that it could be herpes (until my son requested a test). He explained that most of his practice has been in the ER and urgent care and that this is not something they typically see. He talked to my son again over the weekend, because I was concerned about depression, and told him he was going to do some more research and planned on contacting the CDC today. My assumption is that they will probably inform him that the IgM is not the most accurate test and he will order a new test.
To answer your questions, yes he was the giver of oral sex and there was no intercourse. The lesions in his mouth were not swabbed, they only did blood work. He has not had any sores on his lips. He started to develop a fever blister last night, I noticed it and immediately picked up Abreva and he’s been applying that regularly. It appears that it is going away. It was definitely the early stages of a fever blister, his bottom lip had a small bump (or swollen slightly) and a few tiny dots/blisters on top of the bump. This morning I could not see anything.
What was in his mouth did not look like cold sores or lesions to me. They were raised and were all white on top of them. Two of the three doctors he saw described them as puss pockets. They were all concentrated at the back of his mouth near his throat and tonsils. There were not any near the front of his mouth or on his tongue.
Again, thank you very much. Your advice is greatly appreciated!

[Concerned Mom]

One more thought I have, if it were a male he had oral sex with would that make a difference regarding symptoms he may have? I don’t know if this is the case and do not want to ask. I would rather allow him to discuss that with me if/when he feels like. This may not even be the case, but being that it was oral I would think if he is positive he would’ve had symptoms on his lips or tongue.

[Concerned Mom]

The cold sore/fever blister on his lip is gone. He has one small sore in his mouth. It looks like a small bump with a white head. It is inside his cheek, this is the first one he’s had that was not in the back of his mouth.

[Terri Warren]

If it was a male he gave oral sex to, it would be more likely to see infection farther back in the throat. I would strongly suggest that any mouth lesions be swab tested using PCR as the method of swabbing. And then, in about 12 weeks, he should have the IgG HSV 1 and 2 antibody testing done.

Terri

[Concerned Mom]

Terri I am not sure if I am have a followup question allowed…but I wanted to know if my son did contact HSV 2 orally, what is the likelihood he would get it on his genitals? Will it travel from his mouth to genitals? It was only oral sex and he was the person giving the oral sex. He is scheduled to have the IgG test in December. Thank you!

[Terri Warren]

HSV 2 does not travel from the mouth to the genitals no, it stays in the same nerve group (head and mouth). Good that he is going to have the IgG test done in December. If it happens to be positive and it is below 3.5, he needs a confirmatory test done.

Terri

[Author]

Posts