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Had primary outbreak on genitals. Taking anti viral medication. How was that possibly that test for IGG will come back neg?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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I hI have recently had primary outbreak on my genitals. My Dr did a PCR test an it showed HSV2 my antibodies IGG came back Neg. Dr order an other test in3 months since thats how long it takes for Antibodies to develop. He put on a 6 month treatment of anti viral medication. I have only had 2 partners in the last 6 month they are both IGG neg. How can that be is there possibility that my test for IGG will come back neg in 3 months
Posted Fri, 8 Nov 2013 in Skin Hair and Nails
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer:
IgG comes after 3- 6 positive months of infection

Detailed Answer:
Hi,
Welcome and thanks for posting your query to healthcare magic.

I have gone through the history provided by you. I can get that you are suffering from herpes genitalis and confused about the IgG status of the same.

To tell you regarding your problem- Herpes is a viral infection characterized by fluid filled small vesicles. If it is present on face then it is type 1 (HSV1)and if it is present on genitals then it is type 2(HSV2). It is a recurrent infection and can occur in 2-3 months again.

In any of the infection, as it comes in body then body secrets antibodies against them. The initial antibodies are always IgM in all the persons. This is present for first 3-6 months after infection. It is the first antibody to be expressed after every infection and shows latest infection.

After about 3- 6 months of period of infection this IgM is replaced by IgG antibody. This shows the significance of the infection in past. So it is late onset antibody and comes after 3- 6months of infection.

So coming on to your query- AS you have recently had the infection so it is quite obvious that IgG will not be positive. It will be show its status after 6 months of infection. So clear this thing form your doctor that it is not for the negative status after 3 months but it is to see whether the infection is mounting late respnse antibodies or not. Your doctor has correctly put you on a prophylactic treatment of herpes so that the recurrence should be least side.

In terms of partners too- In both IgG is negative but the status of IgM is not clear. HSV2 is basically sexually transmitted infection and most commonly form partners. Ask your partners for the status of IgM or best would be PCR test.

Anyhow herpes is a very simple condition and never cause any issue in future life. So do not worry about this problem.

I hope it cleared all your doubts.

If you have any further doubts I will be happy to help.

With regards,
Dr Sanjay
MD Dermatology
Above answer was peer-reviewed by
 
Follow-up: Had primary outbreak on genitals. Taking anti viral medication. How was that possibly that test for IGG will come back neg? 8 hours later
Thanks for your reply,

understood. So is there a chance that my IGG will come back neg. in 6 months that the Anti Viral meds. caught the virus early enough before it could significantly replicated. Neither of my two partners have been with anyone for more then 6 months nor are they showing any signs of Outbreaks. So the IGM will not show any anything.
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer:
Kindly see the details below

Detailed Answer:
Hello,

Welcome and thanks for your prompt reply.

Now it is good that you understood the problem correctly. To guide you further the first thing I want to suggest you is to not to get confused with antibodies and herpes itself.

The antibodies to herpes are not of protective nature. There is no correlation of protection of the disease and antibodies because these antibodies do not prevent the disease occurrence. That is why herpes is a recurrent disease occurring again and again.
So the antibodies should not be seen with prevention of disease which you might be trying to correlate. The antibodies only show a latest infection by IgM and late infection by IgG. Therefore do not get confused with any of these antibody positivity or negative status. IgG if becomes positive will only show that the infection has occurred in past. IgM or IgG are of no significance in disease prevention in any ways.

Your doctor has prescribed the antiviral on the part of the fact to prevent the longest possible recurrence. We have seen that as much as we prevent the second episodes there is less chances of recurrence. You can talk to your doctor regarding the explanation of the same. The course of antiviral is a prophylactic therapy to prevent the recurrence which is longest possible.

Regarding your partner’s status- the basic cause of the problem is sexual transmission. So you can go for PCR of your partners to know exactly whether they are infected or not.

Lastly I want to reassure you that herpes is a very common infection which we see too frequently in our practice. It never causes any serious effects in future life and there fore should not get panicky for the condition.

I hope it cleared all your doubts. If you have any further doubts I will be happy to help or if not then can close the discussion and rate the answer.

With regards,
Dr Sanjay
MD Dermatology
Above answer was peer-reviewed by
 
Follow-up: Had primary outbreak on genitals. Taking anti viral medication. How was that possibly that test for IGG will come back neg? 1 hour later
Thanks I appreciate your follow up.


The parnters do not have any Out Breaks what would they do a PRC on? My question how can all three of us be Neg for IGG. One partner has not been with anyone in two years IGG Neg, the other more then 8 Months since her birth tested during prengency she is also IGG Neg. Niether have any symptoms. I have a outbreak postiive PRC for HSV2 Neg IGG. Something does not make any sense.

What if in 6 months my IGG is Neg? What would that mean? Is that even possible ?
 
 
Answered by Dr. Sanjay Kumar Kanodia 15 hours later
Brief Answer:
Kindly see the details below

Detailed Answer:
Hello,

Welcome and thanks for asking further queries.

Regarding your further queries:

First and foremost of the thing is that- kindly stop thinking about IgG. It is a simple antibody test in herpes which tells us about the fact that herpes occurred in last 6 months or more of the period. Its positivity or negativity is of no significance in disease prevention.

As you have had your herpes infection in less than 6 months only so IgG will not be coming positive in your case. It is totally variable form person to person to have IgG positivity in 6 months or more. Sometime it may not show its positive for many a months. This is all dependent on serology. I have seen many cases where it comes negative then positive and then again negative. So this serology of Ig G does not have any significance with your disease of herpes. Even after say 6 months of period if it comes positive then it will be only showing that you had infection. So the most important and foremost thing is IgG is beyond our discussion.

Now I asked for PCR of your partners to know exactly which partner is infected. It is not rare to find that one of the partners may harbor the virus without showing its clinical symptoms or outbreaks. In these cases they may silently pass the disease to the other partner. Here itself the serology is not positive for IgM or IgG. Therefore in these cases to find out the exact source we go for PCR tests which detects the herpes virus itself if present.

Let you understand one more fact that – it is the causative organism which comes in body. It may or may not manifest the clinical symptom or break out but can be present silently. If it is not manifesting outbreaks then antibodies may not be formed. So the serology of IgM and IgG will be negative. In those cases to detect the virus we go for PCR or Polymerase chain reaction which detects the virus and therefore is conclusive test.
I hope you understood the basic facts which even some times medical students are really confused!!!

Do not worry; Do take your antiviral medicine for the longest possible time to prevent the future recurrence.
I hope it cleared all your doubts. If you have any further doubts I will be happy to help or if not then can close the discussion and rate the answer.

With regards,
Dr Sanjay
MD Dermatology
Above answer was peer-reviewed by
 
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