[Question #1825] Herpes testing and molluscum

42 months ago
Dear Doctors,

In the past 6 months, I've had 2 casual partners. Always used condoms for vaginal sex, but I gave and received unprotected oral sex.

5-6 weeks ago, I noticed some bumps on my pubis. They were painless, firm, raised, round and some appeared to have a dimpled center. Some had a white center and resembled pimples. 

3 weeks ago, the bumps were still there, so I visited an urgent care. The Dr thought it could be molluscum. He ordered an STD panel and took a sample from one of the lesions. 

Results were negative, except for HSV IgM, which came back positive (1.30). HSV 1 and 2 igG were negative. A culture was not done because of an ordering error, but, NAA tests for HSV 1 and 2 were negative. 

Both the Dr on duty this time and my PCP the next day thought the results indicated a recent exposure. At this time, I started seeing smaller, itchy bumps on my arms, hands, stomach and ear. Neither Dr could explain these, but I think it's the MC spreading. 

I also noticed that my upper gums were inflamed and had a small sore. PCP said it was probably unrelated. He prescribed Acyclovir and gave me a referral to a dermatologist. 

I'm still waiting for the derm, but the Acyclovir seems to be helping against the (potential) MC (I've read anecdotal reports that systemic Acyclovir can help).

Is it reasonable to suspect that the IgM was a false positive? I intend to get tested again once 6 weeks have elapsed since my last possible exposure. 

Thank you very much!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
When I see clinicians ordering IgM tests, it just makes me want to tear my hair out.  Their reputation as a terrible test has been around for years and years and the CDC in their STD treatment guidelines of 2015 say very clearly never to use them.  In my experience, about 7-8 times out of 10, a positive on the IgM and negative on the IgG is a false positive - that isk, the person never becomes positive on the IgG test.  So what  shame that these physicians do not understand the use of this test (it has no use except in newborns) and scared you.  Getting tested again is a good idea as the test is not wrong 100% of the time.  However if you want an accurate test I will tell you that acyclovir can interfere with antibody development so if you want an accurate IgG test in 6 weeks, you may wish to reconsider taking the acyclovir. 
The lesions sound very much like mollusucum - location, physical description and umbilication.   And good that a culture wasn't done - you want NAAT testing, far more accurate and good that it is negative. 
If the bumps on other parts of your body are umbilicated with a hard cheesy center then they could be molluscum, but in my experience, when acquired genitally at first, I've rarely seen it spread to other parts of the body

Terri
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42 months ago
That's really good to know, thank you so much Terri!

Overall it's been a sobering experience. When I went to my PCP, I mentioned that I'd read that IgM testing had known issues and he said he "didn't know anything about that." He then said the results seemed indicative of a HSV recent exposure and that if we treated with antivirals now, I had a narrow time window to "knock the virus out", otherwise it would stay with me for life. As far as I know this is blatantly false, so it's hard to trust his judgment about anything else. Time to find a new PCP! 

Currently I only have one pubic lesion left, looks like classic molluscum. I stopped the acyclovir until further confirmation and a visit with the dermatologist. I haven't popped any of the  bumps on my arms and stomach and they're too small to see a dimple, although a few look like they have  a black dot in the center.  I'm guessing the sore on my gums is likely just a canker sore brought on by stress. 

Currently, it's been 4 weeks since my last possible exposure. When do you think would be a good time to retest? Should I retest for all the other STIs that I was negative for? Only order HSV 1 and 2 IgG, no more IgM, correct? 

Thanks again, I really appreciate your help! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
I would have to disagree with your doctor about taking the antivirals "knocking the virus out".  I know of no evidence for that, unfortunately, at least not at this point.  I think you might want to wait until 6 weeks from the exposure for a bit more certainty.  If you are negative at 6 weeks, there is a 70% chance it will stay that way.  The things on other parts of your body really don't sound like molluscum to me but worth keeping an eye on them to see if they change much.
your PCP may be very good with other issues - not many do a good job of keeping up herpes stuff, I must say.  May not be a reason to switch, your call of course.

Terri
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42 months ago
Hi Terri,

Saw a doctor at Planned Parenthood today, she was terrific and confirmed that I do in fact have molluscum (which is almost resolved). She didn't recommend getting further bloodwork, but since I stopped taking the acyclovir, I think I'll still get the IgG 1 and 2 tests in a few weeks for peace of mind and for the sake of future partners. 

Still no word on the body rash, but I'll go see a dermatologist soon. 

Thanks so much for the help, I appreciate you taking the time and hope you have a lovely weekend. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
You are most welcome, very happy to help!  You have a great weekend too.  I'm so glad you pursued this further. 

Terri
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