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Dear Terri,
I want to thank you so much for your forum. I appreciate all the work you do to provide solid answers. I’m pretty scared and anxious, so thank you in advance for your help. To begin, I have not had vaginal or oral sex in the last four years. After breaking up with an ex-boyfriend four years ago, I had HSV1 and HSV2 IGG testing done. My HSV2 IGG was negative, and I think this was done about 3-4 months after my last sexual contact with my ex-boyfriend. My HSV1 was positive, as I’ve had HSV1 since I was 18. Two years ago, I dated a man but did not have sex with him, though we did kiss a lot. At one point when we were kissing he ejaculated onto my genital area, which was fully clothed. I’m a bit of a worrier, and went through STD testing three months after our last physical contact. My results were: HSV1 IGM-Negative. HSV2 IGM Positive. HSV2 IGM Titer with IFA procedure- 1:20.
I was terrified when I heard this, and my doctor told me to test again later. I waited till seven months after my last physical contact with the ex, and my results were: HSV1 IGM-Negative. HSV2 IGM-Negative. HSV1 IGG- >5.00
HSV2 IGG <0.90. My questions are:1. Does this mean that I am negative for HSV2, or is there some chance that I have HSV2 because of the positive IGM?
2. At the time of the first blood test, I’d just gotten over an oral HSV1 outbreak, but my HSV1 IGM was negative. I heard something about an anamnestic response, but I don’t know what that means.
3. Since I only kissed my ex-boyfriend, what is the chance that he infected me with HSV2 oral? Or could I have contracted HSV2 genital from him ejaculating onto me?
4. Could I have HSV2 too low for the test to detect, but actually be positive for HSV2?Thank you so much!
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Yes, it means that you are HSV 2 negative. The IgM is a very troubling test in that it has lots of false positives and the CDC recommends that it not be done at all. I don’t believe at all that you are HSV 2 positive. someone ejaculating onto your genital area when you are fully clothed presents zero risk of acquiring HSV 2. And you don’t even know that he has HSV 2 right? I would also not worry about contracting HSV 2 from kissing. What shame that the IgM test was done and that it has scared you in this way.
Terri
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I don’t know what you mean by titer/IFA. Are you talking about the IgM here? The IgM is a terrible test, in my opinion. When this happens, people get a positive IgM and a negative IgG and down the road the IgG is still negative, it is almost impossible to get some people to believe that the IgM was just plain wrong. In your case, you have waiting more than enough time to test positive by IgG if you were going to. We advise waiting 3-4 months for accurate IgG testing – you have waited 7, right? I think you should show your doctor the CDC STD treatment guidelines that direct clinicians not to use IgM tests.
The traditional blood screening test misses 2-3 infections out of 100.
If you want to know if your cold sores are HSV 1 or 2, have a PCR swab done of the outbreak to be sure. You can also get a herpes western blot, the gold standard test, if you really want to be sure.Terri
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I wonder if your doctor’s office could do a culture? If yes, then have a culture done. It is better than nothing. Did the doctor think this looked like herpes to them? What lab do they use ,do you know?
The PCR looks for virus (as does culture ) and the westerns blot looks for antibody – very different things.
We can make little sense of results from an IgM test so I’m not going to answer that question because the test so often mixes things up. The western blot will pick up a few more cases of HSV 2 than the screening test, yes. If you feel that would help you relax about this then by all means do take it. You would need to order this through our clinic or directly through the University of Washington. I am going to be out of the country for another two weeks but could order it for when you when I get back if your want to wait.Terri
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Western blot will pick up only a few HSV 2 infections that the western blot does not.
Cold sore appearing in more than one place does not indicate HSV 2, not at all. it is quite normal for the virus to move around. I disagree with your doctor on this.
PCR swabs look for virus while western blot looks for antibody – very different. PCR is used when there are active sores that can be swabbed but western blot can detect infection when someone has no symptoms at all.You have two questions remaining.
Terri
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1. When I was 18, I was diagnosed with genital herpes by culture, not PCR. For years I thought I had genital HSV-2, until I did IGG HSV tests when I was 26. The IGG tests came back positive for HSV-1 only, and HSV-2 was negative. I repeated this test several times, and the HSV-1 IGG was always a high positive, with HSV-2 IGG always negative. After one primary genital outbreak at 18, I have never had another genital outbreak. However, I started noticing oral cold sores when I was 26. My question is: do you think that I have genital and oral HSV-1? All the bloodwork and symptoms seem to indicate this. However, I read that having HSV-1 in two locations is rare. If I do have oral and genital HSV-1, is it normal that I would not have any oral symptoms until almost 8 years after the initial infection?
It isn’t all that unusual to have HSV 1 orally and genitally and they are almost always acquired at the same time. And many people with HSV 1 orally don’t have any recurrent symptoms.
2. Given that oral and genital HSV-1 together is rare, do you think that the bloodwork has been wrong and I could have HSV-2? I know this is unlikely, but my symptoms seem so out of the ordinary. Is it possible that I could have HSV-2 even after years of negative IGG HSV-2 tests?
No, I think you have HSV 1 only.
3. I have also struggled with pain from vulvodynia. I am certainly no expert, but do you think my vulvodynia could stem from my genital HSV-1 outbreak years ago? Is it possible that HSV-1 can cause post-herpetic neuralgia?
I don’t believe so, no, since it is HSV 1.
4. I read somewhere (might not be accurate) that if you have HSV-1 and HSV-2, it can be very hard to get an accurate ELISA test answer. Do you think this is true, or should I trust the results of my previous HSV IGG tests?
I do not think this is true, no. I believe you can certainly trust your HSV 1 positive result and the test for HSV 2 picks up about 97-98% of infections so unless you want to do the western blot to pick up the extra 2-3%, you’re good.
terri
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1. The words that run through my head about your GyN’s advice are not acceptable in print. That is not what is going on here.
.2 The risk of acquiring HSV 2 from inantimate objects is zero except sex toys you might share with an infected person
3. While it is probably possible to be infected through tears, sperm and vaginal fluids, it is not likely. Sperm in particular, alone, is not a good carrier of virus. Tears, interesting are a good carrier of HSV 1. Vaginal fluid that has passed over the genitals might be contagious.Terri
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1. This is probably a silly question, but if someone is negative for HSV-2 on an IGG test, why isn’t the number zero? Does this mean that the person has some small amount of HSV-2 in their blood?
The number isn’t zero because each and every blood sample in that “run” is compared to a control sample – both a negative and a positive control – to see what their value is. There is almost always a value – it is a light density question and I think way beyond what I can explain more. If the comparison sample was water, maybe it would be zero, I really don’t know.
2. I dated a man briefly over the summer, and we did not have any type of sexual contact except for one mouth-to-mouth kiss. Do you think I need to worry about catching HSV-2 from kissing alone?
NO
3. I definitely want to do the Western Blot test, just for peace of mind. I’m very glad this test is the gold standard, and I read that it tests for several more peptides than other tests. Is it possible that someone could have HSV-2 peptides that just don’t show up on a Western Blot? Or could they have HSV-2 too low to be detected?
I have had 9 patients in 33 years of practice who have had a positive swab test for HSV 2 and a negative western blot. That’s it.
4. Last but not least, if the Western Blot is negative for HSV-2, do you think I can say with certainty that I don’t have HSV-2 at all? I want very much to put this behind me, but I am still scared. Just in your opinion, with the tests I’ve already done, do you think I am probably negative for HSV-2?YES!! And we can help you with the western blot for sure.
Terri
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Yup, you just the call the clinic and set up a phone consultation with me, we’ll take care of the rest
Terri
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