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  • What I know...is that I know nothing?! :mad:

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    Old 09-20-2006, 08:38 PM   #1
    CloudySkies
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    Unhappy What I know...is that I know nothing?! :mad:

    First let me just say, surprisingly I'm handling my diagnosis rather well...compared to when I first found this wonderful group of people! So thank you...the support and words of wisdom have helped tremendously!

    BUT....here's the thing......
    ....I'm still very confused and now some what frustrated...........
    My Dr. confirmed 2 weeks ago that I tested positive for the IgM blood test but negative results came back from the IgG test. Now please keep in mind, I live in Winnipeg, MB, Canada - where testing for H is a joke! From what I've been told, it seems over here in my part of the world we don't have type specific testing and for that matter, until about 3-4 yrs or so ago, us Canadians had to go to the U.S. for blood testing as it was not done here (or at least not in the city I live in!). We are not nearly as up-to-date with such testing as the Americans clearly are....kudos to the U.S.!!

    Anyway...sorry, got off track a bit there (lol)....I also had a positive result from the culture test...a swab of the sores was done about 5 days BEFORE the blood test(s), where I found out a week later it was positive and the following week I got the blood results back.

    My Dr. is telling me that because I tested positive for the IgM blood test and negative for the IgG test, this leads her to believe that this is an accute reaction/result from a recent exposure, "likely within the past few weeks to a month or so" were her words. She said because of the symptoms I experienced (which were indicative of an inital OB) and because of the blood work coming back with the results mentioned above, she was almost certain the exposure was a recent one. Is this true??? It just seems that one Dr. says something so different from the next....causing even more confusion!

    Can someone who has knowledge of this please shed some light for me? I mean really, what is the difference between these tests (IgG and IgM)? How is it that she's certain it's a recent exposure??

    Last edited by CloudySkies; 09-20-2006 at 08:49 PM.

     
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    Old 09-21-2006, 06:06 AM   #2
    over21
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    Re: What I know...is that I know nothing?! :mad:

    You doctor is sort of correct for your case, but if you didn't have a positive culture test, she would be very incorrect. Confusing huh?? That's because Herpes testing is very confusing, even here in the States.

    A positive culture test is direct proof of the actual virus (they actually grow it), so unless the samples got swapped with someone else's, it's 100% and reveals the location (oral or genital). Because of timing issues, a culture is commonly false negative. Meaning a negative culture test is not proof that you don't have the virus.

    A blood test is an indirect test, looking for the existence of the antibodies not the actual virus. There are IgG antibodies are specific to Herpes, the IgM antibodies are not specific to the herpes virus. The IgG antibodies can develop as soon as 3 weeks, most people will take about 6-8 weeks, some 12-16 weeks and some with a preexisting cause of HSV1 (coldsores) can take 6 months or longer. What that means is the longer you wait, the higher an accuracy of a negative blood result.

    In theory, the body produces immunoglobulin M (IgM) antibodies first, to a variety of infections, and immunoglobuin G (IgG) antibodies later. Over time, IgM antibodies tend to stop being produced entirely. Therefore, a test for IgM antibody to any particular infection may be positive before a test that detects IgG antibody. And in a person infected a long time previously, IgM antibody is absent but IgG persists.

    That's the theory, but has been proven wrong in many studies. IgM doesn't necessarily mean a new infection; and absence of IgM doesn't necessarily mean a longstanding infection. What all this means is a positive IgM test doesn't mean you do have the virus and a negative IgM test doesn't mean you don't. This is why the IgM test should be avoided. Several labs in the US have stopped performing the IgM test because the results are so confusing and unreliable.

    What's important about your cause is you have a positive culture (direct proof) and a negative IgG test at 5 days. This would lead one to believe this is a recent infection (usually within the last 16 weeks). If a follow up blood test at 16 weeks is positive, then it's 100% proof that your current infection is recent. If you've have several partners within the last 16 weeks, you won't know for sure which one passed the virus on to you.

    The HerpeSelect blood test for HSV1 and HSV2 is the most common FDA approved test in the US, and was approved for use in Canada in 2001. It might be a little harder to find but it's there. You might consider calling Focus Technologies, in Cypress, California to see if it's marketed under a different name in Canada.

    Questions: Did your culture get typed for HSV1 or HSV2? That's VERY important. Was your IgG test negative for both HSV1 and HSV2?

     
    Old 09-21-2006, 11:10 AM   #3
    CloudySkies
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    Re: What I know...is that I know nothing?! :mad:

    Quote:
    Originally Posted by over21
    The HerpeSelect blood test for HSV1 and HSV2 is the most common FDA approved test in the US, and was approved for use in Canada in 2001. It might be a little harder to find but it's there. You might consider calling Focus Technologies, in Cypress, California to see if it's marketed under a different name in Canada.

    Questions: Did your culture get typed for HSV1 or HSV2? That's VERY important. Was your IgG test negative for both HSV1 and HSV2?
    Thanks so much for the reply back...though still some what confusing, it makes more sense now.

    In response to the above, I was told by my Dr. that type testing blood work is now available in Canada, however, only in certain locations (Toronto being one of those locations - apparently there are only 3 locations across the Country that have the ability to screen for the specific type, as far as my Dr. is aware).

    That said, when speaking with my Dr. about my results, I did ask if there was any indication or way of knowing which type I carry. She said with the testing done here in Canada (or I guess more specifically the city of Winnipeg, where I reside), none of the results can confirm as to which type (not even the culture test it seems). I'm assuming in the U.S. the results of a culture swab (if positive) are indicative of the specific type as well? It's so sad how behind Canada is when it comes to our health care (a whole other story not belonging in this thread!).

    As for the IgG results, all she said is that those results game back negative (therefore I assume that means for both types as the testing done here isn't able to determine the type).

    So basically, if my cutlure came back positive (which it did - 9 days after the swab was taken, with the sores appearing approx. 24-36 hrs before the swab was done) and being that my blood work for the IgM came back positive (September 6/7 - approx. 16 days after the sores began to appear) what would now be the point in folow-up blood work? Sure at some point the IgG results will come back postive but at this point we already know this, so my confusion now is why does this matter or does it matter?

     
    Old 09-21-2006, 12:21 PM   #4
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    Re: What I know...is that I know nothing?! :mad:

    Quote:
    Originally Posted by CloudySkies
    what would now be the point in folow-up blood work? Sure at some point the IgG results will come back postive but at this point we already know this, so my confusion now is why does this matter or does it matter?
    If you never plan on having sex again, then a follow up test isn't necessary. However, knowing what HSV type you have will help determine the risk to someone else. Especially if they know their complete HSV status.

    Basic facts about HSV are you can have either type (HSV1 or HSV2) in either location (oral of genital). 60-80% or the population has oral HSV1, also known as cold sores or fever blisters. Genital HSV1 is gaining in number because Oral sex is so popular. Oral HSV2 is very rare, something like less then 3% of all oral herpes are type2 (don't quote me on that figure).

    You didn't mention the location of your outbreak, so I'll assuming genital. If your infection is genital-HSV1 and you starting dating someone who has a history of coldsore (which is typically hsv1), then the risk level is about zero. Once you develop antibodies to the virus, the chance of getting infected in the other location is about zero.

    If your infection is genital HSV1, but you incorrectly assume it HSV2 and meet someone who really is HSV2, you could become infected in the genital location with HSV2. Meaning, yes, can you have both types (HSV1 and HSV2) in the genital location, there's plenty of room down there for both.

    So knowing what type you have is very important as you move forward.

     
    Old 09-21-2006, 03:36 PM   #5
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    Re: What I know...is that I know nothing?! :mad:

    Quote:
    Originally Posted by over21
    If you never plan on having sex again, then a follow up test isn't necessary. However, knowing what HSV type you have will help determine the risk to someone else. Especially if they know their complete HSV status.

    So knowing what type you have is very important as you move forward.
    Well that does make sense now doesn't it...geez, too much information to absorb...but necessary no doubt. The problem with this situation is that I don't have access to the type of testing required to determine the specific type, the city I live in does not have these tests as yet (and who knows when we will?). The cities in Canada that do, I live too far away from....going to Grand Forks or Minneapolis in the U.S. is closer for me! If I did that, not only would it cost me in travel but the test itself isn't covered either. Maybe there's a way to have my Dr. order a type specific test here in Canada, if that's possible?

    Something I shall look into that's for sure!

    Thank you again for all the help and clarification, I appreciate it very much!!

     
    Old 09-22-2006, 05:25 PM   #6
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    Re: What I know...is that I know nothing?! :mad:

    Quote:
    Originally Posted by CloudySkies
    Maybe there's a way to have my Dr. order a type specific test here in Canada, if that's possible?
    Reviewing your posts, I not sure you're doctor is up to speed on where to test in Canada. I would be shocked if there were only 3 locations in all of Canada. I'm assuming she's referring to the HerpeSelect test, which should be all over Canada. Do your research, make some calls; tell them you're doing a school paper on Herpes and looking for information. Don't assume the person you're talking to is an expert. Ask them the type of test, brand name of the test, what lab does the actual test. If they say IgM, you'll know it's the wrong test. Beware, there are some older IgG non-type specific tests out there. If it's negative, you can trust it. However, if it's positive, you won't know for what type, which isn't much help since 60-80% of the population has HSV1.

    Good luck.

     
    Old 09-24-2006, 12:47 AM   #7
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    Re: What I know...is that I know nothing?! :mad:

    Thanks for all your help! I'll start making those calls Monday and see what I can find out?

    I have one more quick question...if you don't mind me picking your brain a little more? lol

    With regard to the IgG test (and yes the one I had done was a non-specific type test), if I was actually exposed to the virus in say late May/June sometime, is it possible that the IgG results (blood was drawn August 28th or 29th) would come back negative?

    In all the reading I've done and all I've read in this forum and others, it seems the antibodies specific for the IgG test can take up 12 weeks (and sometimes longer) before they'll show giving a positive result, correct? Or am I mistaken?

    I ask this as there seemed to be some things going on in May/June that were very strange/odd...especially for me. In the reading I've now done with regard to this virus, it seems common symptoms can be headaches, tingling feet and so on....even before the initial outbreak....is this correct? I was having a lot of headaches, extreme fatigue, tingling sensations in my feet (2-3 times) and my head felt very cloudy/foggy much of the time. Theses symptoms got better and pretty much went away, but then mid to late July I started experiencing pain often during urination...was treated as a UTI. Then it was mid August the fever/chills started, on and off for about 2 weeks and then the sores appeared and the fever/chills/aches/pains got much worse during this time as well. I'm curious, can you have some symptoms of the virus like that before the sores/blisters appear? If you can, could it be that I was experiencing symptoms as early as May/June but didn't actually have a full outbreak (or is it called the initial outbreak) until August 22/23 when the sores first appeared?

    Still trying to get my head around all this stuff....the timing, the symptoms, the timing of the tests, etc.

     
    Old 09-24-2006, 09:29 AM   #8
    over21
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    Re: What I know...is that I know nothing?! :mad:

    The first two things you'll learn about this VERY common virus, is it messes with your head more than your body, and this virus acts differently in everyone.

    Some people will develop detectable antibodies as soon as two week, about 50% by week 6, and most by week 10. After that they just continuing to trickle in. By week 16 just about everyone has seroconverted (turned blood test positive). The however to this is that there are a small percentage of people who will take longer than 16 weeks, some times 6 months to a year. So, the longer you wait the higher the accuracy of a negative blood test result.

    A typical outbreak will happen 2-20 days post exposure. More typical is the outbreak to be so mild it goes unnoticed or misdiagnosed as something else (jock itch, yeast, etc). This helps explain why 90% of the 1 in 4 adults who have genital herpes don't know it. Let me say that again; 1 in 4 adults; 25% of the adults have genital herpes. Meaning there's a 25% chance the next adult you talk to, kiss, have sex with, has genitals herpes, even if they have never noticed an outbreak. Amazing huh??

    Yes, many people will have symptoms but no actual outbreak. A true "primary outbreak" is your first HSV outbreak (type 1 or 2 in either location), weather you notice it or not. A first genital HSV2 out break with a preexisting HSV1 condition is known as "Non-Primary First Episode".

    Outbreak are interesting; you can go years with no outbreaks, or very very mild ones, then BAM, an outbreak from hell. As people say, this virus has a mind of its own, and doesn't play by the same set of rules for everyone.

     
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