Testing: IgG - Good, IgM - Bad

The good news about herpes testing is that more and more clinicians are learning about blood testing that can identify those who are infected but don't know it. The bad news is that they are often ordering a poor test called IgM blood antibody testing. The IgM test, with other viruses, comes up early in the infection and goes away when another antibody, called IgG comes up subsequently.

However, with herpes, there are significant issues with the IgM test. It can't accurately distinguish type 1 from type 2, so a person could be told they have brand new genital herpes when all they have is old cold sore infection. It also can't accurately distinguish herpes simplex virus from other herpes viruses, like chicken pox. And about a third of people infected with HSV 2 make new IgM with a recurrence, so it really can't tell old from new infection, which is often why clinicians order the test.

PLEASE, if you've been diagnosed with herpes by a blood antibody test, get a copy of your results, and make sure they are IgG results, not IgM results. If you were positive by IgM and not by IgG, and at least 3-4 months have passed since your test, ask for an IgG test. If its negative, then the IgM was wrong.

And when you do this, let your clinician know the IgM is not a reliable test for herpes antibody. If it were me, I wouldn't pay for that test, period. Be proactive about your herpes status - be certain your diagnosis is correct.

Related Topics:

• Herpes Tests
• Frequently Asked Questions About Genital Herpes

Technorati Tags: genital herpes, STD, testing, IgG, IgM, sexual health

Who Gave What to Whom?

I very frequently see a patient who has had only one partner for a long time, and they have newly diagnosed genital herpes. Their first question is, "Has my partner been cheating on me?" They often have read somewhere on the internet that symptoms show up within 2-10 days of new infection, and they KNOW they've never had these symptoms before so this must be new!

But the reality is, 90% of those with HSV 2 infection don't know it, so most people completely miss their first infection. Many times, new symptoms aren't new infection, but infection that's been there for years and symptoms are just newly recognized, not newly present.

Do you see the difference there? A person could have genital herpes for 40 years and never know it, and then, for some reason, the symptoms become noticeable, and they immediately blame their current partner for infecting them.

So if you have new genital herpes symptoms, there are some ways to sort it all out.

If you have a positive swab test from a lesion for HSV 2, for example, and you have a negative HSV 2 IgG antibody test, then you have new HSV 2 infection - you have virus present on your skin, but not enough time has passed for you to have made antibody.

If you have a positive swab test from a lesion, and a positive HSV 2 antibody test, you've been infected sometime in the past. However, if you wait 3 weeks from the first time you notice the sore until you get a blood test, you could have made antibody during the 3 week period, so it could get confusing. But if you have an antibody test right away when you notice the sore, and it is positive, then it is very likely an old infection.

If all you get is an antibody test, make sure it is an IgG test. If it is positive (at greater than 3.5), then you have old infection.

If your partner gets an antibody test, and they are negative for HSV 2 and you are positive for HSV 2 on an IgG antibody test, then you didn't get it from them.

If your partner gets an antibody test and they are positive for HSV 2 and you are negative for HSV 2, then they didn't get it from you.

There are many possibilities, and you may need help sorting out the combinations and permutations of antibody and swab testing, but I hope this helps a little.

Related Topics:

• Herpes Tests
• Genital Herpes Health Center

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Sex, STDs, Safety and Your Teen

A recent study by the CDC suggests that 1 in 4 teenage girls have a sexually transmitted disease. This may include the genital wart virus, chlamydia, or trichomoniasis, among others. This doesn't surprise me at all. Sex in teenagers in incredibly common - by age 15, about half of teen girls have had intercourse, and probably more have given or received oral sex. And it often isn't with committed partners; it may be quite casual or fit into the category "buddies with benefits", friends having sex without a romantic attachment at all.

But where are the parents in all of this? Are we doing a decent job of talking with our kids about sex? I don't think so. If you have a teenager, let me ask you this: how often have you talked to your child about giving and receiving oral sex? Its the big thing now, kids have lots of oral sex so they can preserve their virginity and feel like they really haven't had sex. And anal sex is the same - if you've had anal sex, they will tell you, you are still a virgin. Interesting thinking, wouldn't you agree? I have 16-year-old female patients who have had lots of anal sex so they can still be virgins and 45 year old men who would give their right arm to have anal sex once in their lifetime. Its boggles my mind sometimes.

But teens are vulnerable and desperately need frank and honest information. Yes, abstinence would be my preference too, at least for a while, but this really isn't our choice. It is their choice, it is their body, and no matter how much we talk and lecture and pray and hope, they will do what they do, and often that's have sex. They are curious and want pleasure and sometimes drugs and alcohol impair their judgment. Does this sound familiar to you?

How old were you when you first had sex? I made the dubious decision to tell my youngest daughter when that was for me, and at that age, she told me that she first had sex then, too, so it must have been OK. That's a decision I might revisit with my granddaughters someday! But she and I talked a lot about sex - about the risk of getting herpes from a cold sore and oral sex, about the damage that chlamydia can do to fallopian tubes, what HPV can do to the cervix. We talked about all the behaviors that could put her at risk, and we made the discussion a casual, regular thing we talked about because I knew it was on her mind. Her friends sought me out for birth control and STD testing and free condoms and information. I felt mixed, but mostly incredibly glad that they did, that they trusted me and knew they could count on me for straight answers. These teens are very dear, just beginning to explore their worlds, and they need their parents to be the ones who they can turn to for these discussions.

But the truth is not all parents can do it, so it would be good to have a back up person in mind to talk the talk. Teens who are having sex need STD screens, and they need reminders about condom use and they need to hear that mutual masturbation holds no risk and oral sex and anal sex ARE sex and do present some risks of their own. And they need to know their parents love them, even if they are sexually active. Because no matter how uncomfortable we are, their safety and their future fertility and sexual health is what's important, right?

Related Topics:

• WebMD Video: Teens and STDs
• WebMD Video: Teen Epidemic - Chlamydia
• Sex and Teens: When Knowledge Does Not Translate Into Action

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STD Testing - Who is at Fault?

I wonder how many times I've heard someone say to me as I'm diagnosing them with an STD, "But I asked my partner before we had sex and they said they were clean!"

On one hand, its good that the topic of sexual health came up at all. But on the other, how do people really know if they are "clean" anyway? And do you think that we could use some other term for not being infected with an STD? Because the opposite of "clean" is "dirty" and I would really love to see THAT concept go away somewhere and never return. Is it any wonder STDs are stigmatized in our society when that's how we define someone who is infected?

STDs spread largely because people don't know they have them. If someone knew, for example, that they had chlamydia, a bacterial STD, they would get it treated and it would not be spread to anyone else. But about 2/3 of women who have chlamydia don't know they have it, and perhaps a third of men, so it just keeps moving from person to person, not because anyone is "dirty" but because the bacteria stays inside people, unrecognized, even for years, until someone diagnoses it and treats it.

The same is true with genital herpes. Ninety percent of those infected with herpes have no clue. They infect someone else who notices, and then all hell breaks loose - who gave what to whom and how dare you! But its nowhere near that malicious.

Perhaps the irresponsible part relates more to not getting tested before having sex with a new partner. If people did get tested for STDs more often, there would likely be less of them. So whose fault is that? I think the blame falls on both clinicians and sexually active people. Spur of the moment sex with a new partner is hot and interesting and fun, but it really doesn't allow for the time it takes to sort out STDs, does it? Is there a middle ground somewhere in there?

And clinicians - how receptive are they to patients requesting full STD screening? And how good are they at including all the possible STDs that someone might reasonably have? They are notoriously not great about including herpes testing in an STD screen, and that's the most prevalent STD in the US!

I think the burden must fall on the sexually active person who holds off on penetrative sex until testing has been done or least uses condoms for everything until testing can be done.

Or maybe its me. Maybe if I could figure out how to make testing hot and interesting and fun, people would do it more! But that's a whole different blog.

~Terri

Related Topics:

• Get the STD Picture
• When and How to Reveal You Have an STD

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Herpes Stigma

So there's good news and bad news about the social stigma associated with herpes. In a recent phone survey of about 2,000 people in the US, 3/4 without herpes and 1/4 with herpes, a slight majority of both groups felt that the topic of genital herpes was not taboo. But when ranking the social stigma associated with any STD, herpes ranked only behind HIV - but hey, let's face it, there is stigma associated with any STD - it does involve genitals, after all, and we, as a society just aren't comfortable about our genitals.

Another piece of good news was that for people who had herpes, the biggest issue was bothersome symptoms of herpes outbreaks. That was listed way ahead of being bothered by stigma. Outbreaks can be treated or mostly prevented with medicine but there's no prescription for feeling stigmatized by your herpes.

The bad news is that a majority of people who didn't have herpes said they would avoid having a relationship with someone with herpes or break up with a partner who had herpes. Now that is truly stunning to me. This is 2007, folks! Of all of the things that can go wrong in a relationship, herpes is so far down the list, its almost not detectable. I'll bet if you surveyed discordant married couples - that is, couples where one person has herpes and the other doesn't, they would tell you that sex, money, in-laws, household chores and inability to talk to each other cause way more problems than herpes ever could.

It makes my heart very sad to think of the wonderful, quality people that I know, and know really well, who have been turned down for relationships because they have herpes. I used to think that people who did that were scumbags, that they didn't have a good sense of ethics or of what's important in life or that they would be unreliable in future hard situations. But I think a bit differently about that now. Now, I think that often they are just unreasonably afraid, that they know too little about the real experience of herpes, that they are just afraid of the reputation, not the actual disease and that they will never be able to know the "real" herpes.

I also think that people who count a lot on their sexuality for their identity are less likely to take any risk of getting herpes. It's like if you are a pianist, you take extra care with your hands or if your job is to model toenail polish, you take extra care with your feet. If much of your identity is tied up in your ability to be sexual, then you will be less willing to take risks with that part of you. And lest you are thinking, "yea, see, they are scumbags, they are oversexed weirdos", I would say that isn't necessarily true. They just may feel good about the way they look or the things they can do sexually and may not have built up their confidence about themselves in other areas at the same rate as the sexual confidence. We all feel strong in some areas, but not in others, right?

Another group of people who just can't seem to deal with herpes in a partner is people with obsessive compulsive disorder, and this is more common than you night think. And it comes in mild, moderate and severe cases. The severe case is the person who comes into my office and won't touch the doorknobs - they wait for someone else to walk into our suite to let them in, then we have to open and close the exam room and bathroom doors for them because they cannot touch the knobs.

The moderate is the person who is unreasonably fearful about transmitting or getting STDs - like "if my daughter digs through my laundry basket for her pink socks can she get herpes on her hands if I had a pair of jeans in there that she touches" (undies would always be kept separate, of course, and never within reach of the daughter). The moderate might also do lots of hand washing, far more than necessary.

The milder is the person who asks lots and lots of questions about germs and presents several scenarios about getting an STD - like "so if I touch a guy's penis through his jeans, but there is a little wetness from pre-cum on his jeans and I do it without gloves on, can I get herpes under my fingernails?" True, lots of people ask questions about transmission, but if someone leans toward OCD tendencies, the questions have a different feel, are more "out there", are more troubling for the asker.

Another reason someone might not take the risk of getting herpes is simply that they don't know the person who has herpes well enough to take that risk, and that is completely understandable. That's why, when you have herpes, and you meet someone at a party, you don't say, "Hi, I'm Terri, and I have genital herpes." You wait until they know you better, have more invested in you, have more reason to be willing to take some risk. But this discussion must happen before having sex, of course, so they have an opportunity to make the decision about risk for themselves.

The survey also deals with the fact that many people with herpes admit to NOT disclosing their herpes status to sexual partners. But that's another blog.

I'm sure you can think of more reasons why people are reluctant to take the risk of getting herpes, but think of this: do you think it is in one's best interest to chose or not chose a life partner based on whether they have a virus on their genitals that can be well controlled with medicine and causes infrequent symptoms that can also be successfully and easily treated? Are there not more important qualities for a partner to have or not have that will sustain a relationship over time? I think the answer is quite clear. The trick is having people think it through carefully and being brave and sensing what is truly important in a partner.

Terri

Related Topics:

• All About Genital Herpes: Re-Entering the Dating Scene
• WebMD Video: Vaccine to Prevent Genital Herpes

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