I am a nurse who worked at the STD clinic years ago, so I am somewhat familiar with STD's.  My 13 year old, honor roll, sports playing daughter, who does not have a boyfriend told me while I was out of town on business that she had developed vaginal ulcers on 1/13/17.  She did not want her sister or Grandmother who was caring for her to take her to the MD so she suffered (very painful, could not urinate) until 1/20/17 when she saw the NP at a local OB/GYN office.  The NP thought based on clinic exam, she had Herpes.  Started her on Acylovir 5x per day- she only took for 1 day as (mistake number 1)  because we initially we were told tests negative due to cultures (so she stopped taking it) and later told us positive due to blood tests.  Today, 12 days later ulcers are nearly healed.

Test results

HSV Type 1 AB IGG , S <0.91

HSV Type 2 AB IGG, S <0.91

HSV vaginal cultures for HSV1 and HSV2 negative

HSV AB IgM 3.19

(side note gonorrhoeae and chlamydia neg)

I have seen your video

http://www.ashasexualhealth.org/stdsstis/herpes/herpes-testing/

My provider said "it does not matter what type, we are treating the same".  When I told her the internet says IgM has false positives, she did not believe me.  I have grilled my daughter up and down and she denies sex, honestly I don't when she would have had sex, but want to be the Mom with her head in the sand, but I believe her.

Based upon your video.  You would have never tested IgM and likely found her results as negative.  Do I need to prove that this provider is wrong by doing a DNA test or Western Blot?  Do it for my peace of mind and put this to bed?  Do it to confirm IgM was wrong?  Please provide your expert medical opinion.

We have talked to my daughter at length.  We have talked about sex, oral sex, abusive situations, cold sores (she does not have, has not had in the past and does not know anyone with a cold sore), touching...  I have told her we would get a 2nd opinion, but science is science- the tests will still be the same if she has had sex, so if she has had sex, I have asked her to not put herself, and I through all this and also the financial burden that it would bare on our family.  She continues to deny having sex.

She has told me when a girl at school had "hickies" and when some were drinking...she is typically very open to me.

On the drive to the NP, I prepared her before the visit with the NP what it was going to be like, what a pelvic exam was going to be and that they are likely going to think she has Herpes.

As a nurse, I have scoured the internet trying to figure this out.  I failed to mention that she also had a "viral type illness" which she stayed home from school on 1/11/17 (just prior to break out).    Consistent with a HSV break out, but also Acute Genital Ulcers.

A few studies I have found that also show this.  It appears to be rare.  I am reluctant to see other providers as I am not sure who?  Her pediatrician is not well versed on this topic either and has not been less than helpful as well.  I am really not sure which way to turn. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912377/#!po=68.3333

http://jamanetwork.com/journals/jamadermatology/fullarticle/711867

Ulcers are gone now.

As her Mom, what do want to do?  I think what the best course of action is follow your advice.   If we have IgG retested approximately March 1 (this will just over 6 weeks from break out 1/13/17).  You said 70% of those will test positive at 6 weeks.  If she were to wait longer is that better or have better accuracy?  I do not want to go through any unclear results again.

If she has another breakout- see derm. Make sure they do PCR swab test vs a culture .

Then, my question is what provider to do IgG testing?  Obviously her current NP is not educated on the most recent guidelines.  She reviewed these with the MD in her office she told me, so either is he...  I just do not want to go to any provider because I do not want them to automatically assume HSV.  Infectious disease?  FP? A STD clinic at the county? I just don't know and really am discouraged with current provider.  If the current provider followed CDC's guidelines, and not tested IgM, we would think negative test now.  I also I do not want to go in to provider and educate them or be "that Mom" and say "the internet says"...  but I may have to. 

Can you provide me with link with CDC's guidelines that say do not use IgM testing?  I could not find that.  Because I likely will need to provide that to whoever she sees.

When I worked at a local health dept, the CDC is who was referenced.  The link from the CDC you provided states "Providers should only request type-specific glycoprotein G (gG)-based serologic assays when serology is performed for their patients" and also states "IgM testing for HSV 1 or HSV-2 is not useful, because IgM tests are not type-specific and might be positive during recurrent genital or oral episodes of herpes"  But it does not specifically address the false positives, which I wish it did.

So researching more, sleeping on this over night, I think if what I have read and absorbed, she could very easily have HSV.  Can you confirm that my summary is correct.

- The IgG likely will not be positive if this is acute outbreak. (consistent with her lab being neg)- if you have stats for me that would be great.  You said, in 6 weeks 70% of IgG are positive.  Is waiting 12 weeks better- what % of those are positive?

-IgM is typically used to demonstrate acute illness, but with herpes, this does not always happen and sometimes the IgM is positive later when the IgG becomes positive.  Sometimes the IgM can be positive much later after exposure.  And lastly, what I am praying for her case, that there are false positives sometimes.  But my original thinking of her IgG was negative, the IgM shouldn't have been ran, the NP didn't know what she is doing,she is in the clear, why do this to ourselves---is not really a good theory, because of her CLINICAL symptoms of vaginal ulcerations- correct?  So that is why to be sure, she needs retested for IgG.

-Her sisters- they share everything.  Not typically underware, but I can't say that it hasn't happened.  Do I need to worry about them sharing underware or bathing suits?

-If the IgG is positive later, she still does not admit to sex, then what do I do?  Send to a child psychologist? Counseling?  See what they can get out of her? 

I really want to believe her, but I realize that this very easily could be HSV.

Then, on to my MD to get anti-anxiety meds to get me through until March.  Thank you for your assistance and expertise with all of this information.

PS- I tried to get a online evisit with you on West Over clinic, waited several hours yesterday, it never worked.