[Question #1990] Corcerns about STD (HSV2) diagnosis

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86 months ago
Dear Doctors, 

I am having a hard time with some hsv2 tests. I'll try to be brief and give as much information as a I can so you can give me the best advice posible.

I am a 25yo male
Prior medical history: Asthma (well controlled). No STDs until now. 
Sexual history: 7 sexual partners until now. Only unprotected sex with 2 of them, who were my girlfriends at the time. All except but one (unknown girl, one time protected encounter), were known friends, no STDS reported. Last sexual relationship: about a month and a half w/ protection.

History: About a year ago, I noticed two small lump on the shaft of my penis, small papules, about 1-2mm separated from each other, skin colored. No pain, no itching, no burning, no ulcers (I checked pretty carefully); honestly it looked like penile acne or something like that. Went to the derm and urology doctors: they both said it looked like something benign, maybe inflammed penis glands. They both recommended control in 6 months. Again, 6 months from then, same diagnosis, lesions haven't change and no symptoms. They told me it was nothing and got discharged. Again, 6 months from then, lesions still there but a little more hyperkeratotic. I went to some other urologyst who told me it looked like small hpv lesions and cauterized them. I asked him to have and STD panel done because this was my first STD. He ordered many things and this is what is bothering me:

VDRL: Negative
HIV 4th generation: Negative

Herpes IgM ELISA: 1.01 (Index value Negative <0.9; equivocal 0.91-1.1; Positive > 1.1)
Herpes IgG ELISA: 0.15 (Index value Negative <0.9; equivocal 0.91-1.1; Positive > 1.1)

I am very afraid I might have herpes. I have read many guidelines and experts (Dr Hunsfield) who say that IgM is not reliable. What should I do now? 
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Terri Warren, RN, Nurse Practitioner
86 months ago
Good morning,

I'm so sorry you got worried about having herpes.  The IgM test is notorious for it's false positives (and in this case, likely false equivocal values)  and the CDC and all herpes experts suggest that it never be done to try to make a diagnosis of herpes in the adult.  You should ignore the IgM test is you can, though for many people, once they get a reactive IgM test, it is very difficult to put that result on a shelf somewhere and pretend it never happened.  If you are worried, you can retest with the IgG only 12 weeks out from the encounter - I'm quite sure it will be negative.  Your symptoms sound absolutely nothing like herpes but it does sounds like the HPV diagnosis that you received. 

Let me know your thoughts about this - I look forward to hearing more questions that you might have