[Question #7602] HSV 1/2 IGM positive test. What does it mean? What do I do about it?

 
1 months ago
Hello experts,
I recently received a positive IgM HSV 1/2 test result (value 1.14) and am concerned confused about what to do about it.
I recently went to have a long overdue STI screening and it all cam back negative, but shortly after I was contacted by a former female partner (last contact ~1yr ago) who told me that she just found out she had "herpes", didn't know if she got if before/from/after me, and didn't want to give me any other information. My negative STI screen did not include HSV1/2 so I called my provider and asked to have an HSV test for the sake of completeness. He ordered HSV 1/2IgM, which I now know is a terrible test. The test came back positive at 1.14. I have never had any genital or anal lesions or concerning prodromal symptoms. I've never thought I might have genital herpes. Since childhood, I have had a very rare oral cold sores (not sure when the last was).  I'm basically not sure how to interpret this positive test. Should I be concerned I have genital herpes, do I need additional testing, do I need to be on suppression, should I contact previous partners, do I need to stop having sex with my current partner, etc?  This whole thing has caused me significant distress and anxiety, and I wouldn't want to put anyone else through it unnecessarily. Please help me with some advice. (PS- I am a physician if that helps with your reply)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
You are absolutely correct that the IgM is a terrible test and the CDC says never to order it.  The test to pay attention to is the IgG test only.  The IgM can be positive for a multitude of reasons, certainly, your previous cold sore history could be one.  As you can see, not only was an IgM test ordered but not even a type-specific one.  What a travesty.  You don't need to stop having sex with your current partner unless the news alone worries you - not based on this test.  You can order your own IgG test online (or I suppose since you are a physician you could order your own with your own lab).  It's quick to come back.  Just do this and see what you get.  If you last had sex with this partner a year ago, enough time has passed for an accurate result (as accurate as the HSV IgG test gets). 
Let me know what other questions you may have.

Terri
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1 months ago
Thank you for the information. I'm already feeling calmer! Update: This partner has now informed me that she misunderstood the her test results and her conversation with her nurse and does not have an active HSV infection, but has HSV antibodies (still unclear if its HSV1 v HSV2), and her "lesion" was an ingrown hair. (Unfortunately, this seems to be true to form for her). Given this new information and my total lack of any symptoms, would you still recommend getting an IgG HSV2, or would that just be wasted healthcare dollars and adding to the "a little bit of information is a dangerous thing" scenario already at play?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
So her health care provider has also given her erroneous information.  If she has antibodies to HSV 1 or HSV 2, she has infection and all herpes infections are active at times, even when the person has no symptoms present.  So to say it is not an "active" infection is erroneous.  But again, one should check and see if her test is an IgG or IgM and if it is type-specific for HSV 1 vs. HSV 2.

If she is IgG HSV 2 positive (and it sounds like that's unclear), this may be an indication for you to get an IgG test as well, if you had unprotected intercourse with this person over a period of time.  If I was in this situation, I would test.


Terri
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