[Question #5889] HSV2 IgG Negative, IgM Positive and Chlamydia IgG Negative, IgM Positive

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72 months ago
Hello around the end of May I woke up and realised I had a small sore under my clitoris I also realised I had a yeast infection I was a little concerned but thought maybe the sore was apart of the yeast infection it lasted approximately 6 days and I did not take any medication or anything to treat it. Now on the 8th of August I got another sore at the bottom of my inner labia at the entrance of my vagina it was a little itchy if i touched it but no pain or discomfort, my lymph node felt a bit enlarged and sore to the touch i also started feeling like i had a slight sore throat. I went to the doctor and at first she wasn't even able to see it but on closer look she saw it I also had very little discharge and that's when I became concerned that maybe this wasn't from a yeast infection. She never told me that it may be a STD but said my thyroid glands looked a bit large she only prescribed me to take canesten vaginal cream for 6 days I did so and it cleared up when I looked online I saw it was mainly prescribed for yeast infections never say anything about herpes. But i decided to go to a lab and get a full STD testing done and they told me it will take a week to get back the results the only things that came back positive were HSV2 IgM at 16.9 (on the results saying 0.9 means negative and 11.0 means positive)  IgG came back as 0.6 and Chlamydia IgM at 11.7(on the results saying 0.9 means negative and 11.0 means positive) IgG coming back as 0.7. I felt a bit of discomfort in my lower abdomen and saw online this could be from Chlamydia. I've only been with one sexual partner since July of last year so does this mean he recently got the STDs and passed them onto me?
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Terri Warren, RN, Nurse Practitioner
72 months ago
I have no idea why anyone would order a chlamydia blood test.  That's just ridiculous!  Chlamydia testing should be done from a vaginal swab - that could be self collected or clinician collected, but never a blood test.  And the CDC says never to do an IgM test for herpes.  So you got all sorts of weird testing done.  Having said all of that, the other thing that should have been done is a swab test of the sore.  Was that done?  The guidance about testing for herpes is that if there is something to swab, always swab it.  I have significant concerns about what happened at your visit.  The IgG test misses 8% of HSV 2 and 30% of HSV 1, both compared to the gold standard western blot, so the recurrent sore still concerns me.  Very few things in the US cause recurrent sores in the genital area except herpes.  If you were my patients, I would have done a swab test of the sore and if negative, ordered a herpes western blot done only at the University of Washington.  Any clinician can order that test. 

Terri
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72 months ago
Well the thing is i did do a swab of the area but in the results that's what i saw so i was also wondering if the IgM test was from the swab. I'm not sure if the gold standard western blot test is done in my country I asked for full testing of everything and those were part of my results. Its all very confusing and I'm wondering if the HSV IgG test was done too early maybe by my estimate it would have been 13 weeks since the first sore appeared. Also to mention I didn't have any other kind of symptoms associated with it at the time other than there being a yeast infection. Could it be possible to have herpes for over a year and have such a low IgG result. I'm just trying to figure out if this is the case and i do have herpes would it be something i recently got? My partner is showing 0 symptoms of any STD's. I forgot to mention that when I took my results back to my doctor she just looked at it and said yes you have herpes and then she prescribed me something to take for the chlamydia and that was just the end of it.
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72 months ago
But one other thing that comes to mind is there were 2 instances before the rashes where right after having sex with my partner my lymph nodes were really sore this could have taken place earlier within the year I didn’t know what it meant I thought maybe I was in a position for too long and it had gotten sore. And as I said he’s showing no signs of anything at all but I’m still having a slight discomfort in my lower abdomen 
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72 months ago
I think it’s also good that I mention I’ve been taking Depo Provera  for more than a year now and I also had a strange itchy pimple like rash appear on my inner elbow/ forearm area and some other parts of my body in December I wasn’t able to go check it out but I lasted about 2 weeks  
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Terri Warren, RN, Nurse Practitioner
72 months ago
Only 12 weeks from the encounter is required for an accurate IgG test and if yours was done 13 weeks after the encounter, that's fine.  The IgG is a blood test, not a swab test.
Again, the IgM test is NOT the one that you should pay attention to, only the IgG test.  The western blot for herpes is only available in a few countries - I don't know where you live so I cannot say.  It's so unfortunate that this was done at all but what's done is done.  Now your task is to let it go and work on believing the IgG result.  The Depo should have little relationship to this situation.  I know when your doctor says you have herpes it's difficult to say "no I don't" but here is what the Centers for Disease Control says about doing IgM testing for herpes

Terri



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"Both laboratory-based assays and point-of-care tests that provide results for HSV-2 antibodies from capillary blood or serum during a clinic visit are available. The sensitivities of these glycoprotein G type-specific tests for the detection of HSV-2 antibody vary from 80%–98%; false-negative results might be more frequent at early stages of infection (330,332,333). The most commonly used test, HerpeSelect HSV-2 Elisa might be falsely positive at low index values (1.1–3.5) (334-336). Such low values should be confirmed with another test, such as Biokit or the Western blot (337). The HerpeSelect HSV-2 Immunoblot should not be used for confirmation, because it uses the same antigen as the HSV-2 Elisa. Repeat testing is indicated if recent acquisition of genital herpes is suspected. The HerpeSelect HSV-1 Elisa is insensitive for detection of HSV-1 antibody. 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 (337)."---