Herpes Simplex Virus (HSV I & II)-IgM

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Detects IgM antibodies for herpes simplex virus.

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Herpes Simplex Virus (HSV I & II)-IgM Test Information Guide

Why is it done?
- Test Purpose: Detects Immunoglobulin M (IgM) antibodies against Herpes Simplex Virus type I and II to identify acute or recent HSV infection
- Primary Indications: Diagnosis of primary or recent HSV infection; differentiation between HSV I and HSV II; evaluation of genital herpes, oral herpes, or atypical presentations; assessment during first episode symptoms
- Clinical Circumstances: Performed during acute symptomatic phase (vesicles, ulcers, or systemic symptoms); suspected neonatal herpes; meningitis or encephalitis suspected to be HSV-related; immunocompromised patients with suspected primary infection; atypical skin lesions of unclear etiology
- Typical Timing: Ideally within first 7-10 days of symptom onset; IgM becomes detectable early in infection and may be negative in recurrent infections or late primary infections
Normal Range
- Normal/Reference Values: Negative or <0.9 Index (or <10 mIU/mL depending on assay method used)
- Borderline/Equivocal Range: 0.9-1.1 Index; may require repeat testing after 5-7 days for clarification
- Positive Result: >1.1 Index or ≥10 mIU/mL; indicates presence of IgM antibodies
- Units of Measurement: Index (S/CO - Signal to Cutoff ratio), mIU/mL (milli-International Units per milliliter), or optical density (OD) depending on testing platform
- Interpretation Summary: Negative = Absence of acute HSV infection or early in infection before antibody development; Positive = Suggests recent or acute HSV I or II infection
Interpretation
- Positive IgM (HSV I or II): Indicates acute primary infection or recent reactivation; presence of IgM suggests infection occurred within past 1-2 months; type-specific result differentiates between HSV-1 (oral/facial herpes typically) and HSV-2 (genital herpes typically)
- Negative IgM: Suggests absence of acute infection; may occur in chronic/recurrent infections; does not exclude HSV infection if tested too early (within first 5 days) or too late (after 2 months)
- Equivocal Result: Repeat testing in 5-7 days recommended; borderline results may represent early infection, recovering infection, or false positive
- Factors Affecting Results: Timing of specimen collection relative to symptom onset; immunocompromised status (may show delayed or absent IgM response); severity of infection; presence of cross-reacting antibodies from other infections; laboratory methodology variations
- Sensitivity and Specificity: IgM sensitivity ranges 40-90% for primary infection depending on timing; specificity approximately 95-98%; lower sensitivity in recurrent infections (5-30%) as IgM is typically absent in reactivation
- Clinical Significance Patterns: IgM+ with symptoms = acute infection most likely; IgM+ with HSV-2 = genital herpes more probable; IgM+ with HSV-1 = oral/facial herpes more probable; Combination with IgG serology improves diagnostic accuracy
Associated Organs
- Primary Organ Systems Involved: Integumentary system (skin); Mucosal membranes (oral, genital, ocular); Central nervous system; Immune system
- Common Conditions Associated with Abnormal Results: Primary herpes simplex infection; Recurrent genital herpes (HSV-2); Recurrent oral herpes (HSV-1); Herpes labialis (cold sores); Herpetic keratitis/conjunctivitis; Herpetic stomatitis; Whitlow (finger infection); Eczema herpeticum
- Serious CNS Complications: Meningitis; Encephalitis (HSV encephalitis most common cause of sporadic encephalitis); Myelitis; Bell's palsy; Ramsay Hunt syndrome
- Neonatal/Perinatal Complications: Neonatal herpes simplex (disseminated disease, CNS involvement, ocular disease); Intrauterine infection; Spontaneous abortion; Congenital malformations (rare)
- Immunocompromised Patient Risks: Severe disseminated disease; HSV esophagitis; HSV hepatitis; Severe pneumonitis; Chronic ulcerating lesions; Increased risk of secondary bacterial infection
- Ocular Involvement: Herpes simplex keratitis; Iridocyclitis; Anterior uveitis; Corneal scarring; Potential vision loss
Follow-up Tests
- Recommended Confirmatory Testing: HSV IgG antibodies (confirms past exposure and ongoing infection status); PCR/DNA testing from lesion swab or CSF (gold standard for CNS involvement); Viral culture from suspected lesions; Direct fluorescent antibody staining
- CNS Involvement Assessment: CSF analysis with HSV PCR if meningitis/encephalitis suspected; Brain MRI or CT imaging; Lumbar puncture when indicated
- Additional Serological Testing: HSV-1 specific IgG; HSV-2 specific IgG; Repeat IgM testing after 5-7 days if initially equivocal
- Special Circumstances Testing: Neonatal screening: HSV IgM and PCR; Immunocompromised patients: HSV antigen detection, PCR; Ocular involvement: Tear fluid HSV antibodies, PCR; Genital ulcer disease: Type-specific serology for differential diagnosis
- Monitoring and Follow-up Frequency: Initial positive results warrant clinical correlation; IgM typically becomes negative within 8-12 weeks; No routine re-testing needed unless clinical course uncertain; Immunocompromised patients may require more frequent monitoring
- Complementary Diagnostic Approaches: Clinical examination of lesions; Tzanck smear (cytology); Pap smear for cervical HSV-2; RT-PCR multiplex panels for respiratory symptoms; Serology for other viral infections (VZV, CMV, EBV) if indicated
Fasting Required?
- Fasting Requirement: NO - Fasting is not required for HSV IgM testing
- Specimen Collection Requirements: Blood serum sample via venipuncture; Minimum 2-3 mL of blood; No specific tube requirements typically (usually serum separator tube or plain red-top tube); Can be collected at any time of day
- Sample Handling Instructions: Allow blood to clot (approximately 30 minutes) if not using separator tube; Separate serum from clot; Keep sample cool but not frozen for transport; Transport to laboratory promptly (within 24 hours); Some labs accept samples at room temperature, others prefer refrigeration
- Medications to Avoid: No medications need to be avoided prior to test; Antiviral therapy (acyclovir, valacyclovir) does not affect serology results; Patient may be on antivirals without impact on test validity
- Patient Preparation: No special preparation needed; Patient can eat and drink normally; Inform healthcare provider of current antivirals being used; Notify of immunocompromised status if applicable; Provide accurate history of symptom onset for proper interpretation
- Specimen Collection Timing: Optimal timing: Within first 7-10 days of symptom onset; May collect anytime during acute infection phase; Earlier collection improves diagnostic sensitivity; Testing after 2 months may yield false negative as IgM wanes

How our test process works!