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HSV IgM reliability and explanation of results
First of all, thank you so much all of your expertise in this forum. Let me preface my question by saying that I have read your views on the usefulness of IgM extensively. 3 months ago I had unprotected sex and oral sex with my girlfriend. I made her get her blood tested for herpes and other stds, and that ostensibly came back negative. I became anxious that I got herpes from her and have gone to see 3 different dermatologists, a GUM doctor, and a urologist since then. Each one told me to stop worrying and that I definitely do not have herpes. At the 3 month mark after exposure, I decided to get some bloodwork done. Two tests were done, including Herpeselect type-specific IgG and HSV Ab IgM W/RFLX TITER. The results of the Herpeselect showed that I was negative for HSV1 and HSV2. The IgM test, though, initially detected the antibody in the first part of the test, but the RFLX TITER came back negative. My question(s): (1) disregarding whether IgM is useful or not, what does it mean if antibody is detected in the initial screen but the titers come back negative? (2) could it be that my result indicates a recent infection and not enough time has passed for IgG seroconversion? (3) Do you consider my IgM result positive? (4) Lastly, could you give me a brief explanation for false positives in the IgM antibody screen? I know I'm being paranoid, but the reason I'm asking these questions is that I had a confirmed NGU after that encounter which apparently resolved on its own. Thank you so much for your help and this wonderful service!
A related discussion, Do I have Herpes? was started.
I agree with you that I need counseling about this. It has been quite all-consuming. I guess my question was what are RFLX titers? Is the test considered negative if screen detects antibody but titers are negative? I don't really understand why there are two tests within one (screen, then RFLX). Again, thank you, and this will be my last post.
MEDICAL PROFESSIONAL
And this will be my last reply.
We never do IgM testing in my STD clinic because it is useless, and for the same reason I do not keep on on details of the available tests. I suppose RFLX (reflex?) means is some sort of attempt at a confirmatory test. It doesn't matter. Just pretend the IgM test was never done, which it should not have been. Your username says it all. Get the counseling you need and move on.
We never do IgM testing in my STD clinic because it is useless, and for the same reason I do not keep on on details of the available tests. I suppose RFLX (reflex?) means is some sort of attempt at a confirmatory test. It doesn't matter. Just pretend the IgM test was never done, which it should not have been. Your username says it all. Get the counseling you need and move on.
MEDICAL PROFESSIONAL
Let me get this straight. The only person you could have caught herpes from has been tested and found negative. If I counted right, you have been repeatedly reassured by no less than 5 health care providers, including a GUM specialist, that you don't have HSV. You have a negative IgG antibody test at 3 months and you have read the forum to know that IgM tests commonly give false positive results. I don't get it! How much reassurance do you need??
1, 3) The initial IgM result was falsely positive and not an accurate early indicator of HSV infection. IgM test results can easily go back and forth in the same person between negative and false positive.
2) IgG results usually are positive within 3 months. The combination of that test plus the second IgM test proves you don't have HSV of either type.
4) False positive results with IgM antibody testing are common not just for HSV, but for all IgM testing. It has to do with the physical chemistry of the test. They are not caused by partial immunologic reactions to HSV or cross-reaction with other infections.
You need to accept 'yes' for an answer and move on with life. Also look to the relationship with your girlfriend. It's hard to imagine she is relaxed or happy with your compulsive concern and insistance on repeat testing after she told you she is not infected. And what if she were? If it's a caring, committed relationship, that shouldn't matter much. It seems like you would benefit from counseling about all this. I suggest it out of compassion, not criticism.
Best wishes-- HHH, MD
1, 3) The initial IgM result was falsely positive and not an accurate early indicator of HSV infection. IgM test results can easily go back and forth in the same person between negative and false positive.
2) IgG results usually are positive within 3 months. The combination of that test plus the second IgM test proves you don't have HSV of either type.
4) False positive results with IgM antibody testing are common not just for HSV, but for all IgM testing. It has to do with the physical chemistry of the test. They are not caused by partial immunologic reactions to HSV or cross-reaction with other infections.
You need to accept 'yes' for an answer and move on with life. Also look to the relationship with your girlfriend. It's hard to imagine she is relaxed or happy with your compulsive concern and insistance on repeat testing after she told you she is not infected. And what if she were? If it's a caring, committed relationship, that shouldn't matter much. It seems like you would benefit from counseling about all this. I suggest it out of compassion, not criticism.
Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
