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Herpes Simplex Virus II (HSV)-IgM
Bacterial/ Viral
Report in 12Hrs
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No Fasting Required
Details
Detects IgM antibodies specific to: HSV-2: Primarily causes genital herpes
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Herpes Simplex Virus II (HSV)-IgM Test Guide
- Why is it done?
- Test Purpose: Detects IgM antibodies against Herpes Simplex Virus type II (HSV-2), which indicates acute or recent primary infection with HSV-2.
- Primary Indications: Evaluation of suspected primary genital herpes infection, diagnosis of acute HSV-2 infection in symptomatic patients, assessment of first episode genital ulcer disease, and differentiation of primary infection from recurrent HSV-2 reactivation.
- Clinical Circumstances: Typically performed when patients present with acute genital vesicles, ulcers, or erosions; in pregnant women with genital herpes symptoms; during evaluation for neonatal herpes risk; or when there is concern for disseminated HSV-2 infection.
- Timing: Best performed during acute phase of symptoms or within the first 1-2 weeks of primary infection for optimal detection; may be negative in early infection (<5 days) before adequate antibody production.
- Normal Range
- Reference Range: Negative (typically <0.9 index or <1.0 IV depending on assay method used); specific cutoff values vary by laboratory and testing methodology.
- Units of Measurement: Index values or IV (immunoglobulin values); may also be reported as qualitative (positive/negative) or semi-quantitative titers.
- Result Interpretation: Negative = <0.9 index (no acute HSV-2 infection detected); Borderline = 0.9-1.1 index (consider repeat testing or additional confirmation); Positive = >1.1 index (acute or recent primary HSV-2 infection indicated).
- Normal vs. Abnormal: Normal (negative result) indicates absence of acute HSV-2 infection or that adequate IgM antibodies have not yet been produced. Abnormal (positive result) indicates acute primary or recent HSV-2 infection during early immune response phase.
- Interpretation
- Positive Result: Indicates acute primary HSV-2 infection, suggesting recent acquisition of the virus (typically within 1-3 weeks). IgM antibodies develop in response to initial viral exposure and represent the early immune response before IgG antibodies become predominant.
- Negative Result: May indicate no acute HSV-2 infection, recurrent HSV-2 reactivation (where IgM is often absent), or testing performed too early before adequate antibody production. Can also represent absence of HSV-2 infection altogether.
- Borderline Result: Results in the equivocal range require repeat testing in 7-10 days to allow for further antibody development and improved clarity, or confirmation with HSV-2 PCR or viral culture from lesion specimens.
- Factors Affecting Interpretation: Timing of specimen collection (IgM typically appears 3-7 days after symptom onset), immunocompromised status (may show delayed or absent response), previous HSV-1 infection (may show cross-reactive IgM), coexisting HSV-1 infection, and sensitivity/specificity of the specific assay used.
- Clinical Significance Patterns: HSV-2 IgM positive with clinical symptoms = acute primary infection; HSV-2 IgM negative with positive IgG and clinical symptoms = recurrent infection; HSV-2 IgM and IgG negative = no HSV-2 exposure; HSV-2 IgM positive with negative IgG = very early infection or cross-reactivity with HSV-1.
- Associated Organs
- Primary Organ Systems: Genital tract (primary site for HSV-2), skin and mucous membranes, nervous system (peripheral nerves), and immune system. HSV-2 establishes latency in sacral dorsal root ganglia.
- Associated Conditions: Genital herpes simplex, herpetic proctitis, aseptic meningitis, disseminated HSV-2 infection, neonatal herpes (if acquired during delivery), herpetic keratitis (with ocular involvement), erythema multiforme, and recurrent genital ulcer disease.
- Diseases Diagnosed: Acute primary genital herpes, acute HSV-2 meningitis, acute encephalitis caused by HSV-2, disseminated neonatal HSV-2 infection, herpetic gingivostomatitis (when HSV-2 involved), and acute vesicular disease of genital tract.
- Potential Complications: Chronic recurrent genital herpes, neonatal transmission with severe systemic disease, meningitis with neurological sequelae, secondary bacterial infection of lesions, psychological impact of chronic infection, increased risk of HIV transmission and acquisition, and potential complications in immunocompromised patients (disseminated infection, severe mucocutaneous disease).
- Follow-up Tests
- Confirmatory Tests: HSV-2 PCR from genital lesion swab, HSV-2 IgG testing (to assess chronic infection and distinguish primary from recurrent), HSV-1 IgM/IgG (to rule out cross-reactivity or dual infection), and viral culture from lesion specimens (gold standard but less commonly used).
- Additional Investigations: Cerebrospinal fluid (CSF) PCR for HSV-2 if meningitis suspected, MRI brain if encephalitis considered, complete metabolic panel and hepatic function tests for disseminated disease, and counseling regarding sexual transmission and safe practices.
- Monitoring and Timing: Repeat HSV-2 IgM testing in 7-10 days if initially negative but clinical suspicion remains high; HSV-2 IgG can be checked after acute phase to confirm seroconversion; ongoing viral suppressive therapy monitoring for recurrent infection management.
- Related Complementary Tests: HSV-1 IgM and IgG antibodies, herpes simplex viral PCR, direct fluorescent antibody testing, comprehensive metabolic panel, HIV testing (due to increased transmission risk), and rapid plasma reagin (RPR) for syphilis screening in genital ulcer disease.
- Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for HSV-2 IgM serology testing. This is a blood-based immunoglobulin test unaffected by food or fluid intake.
- Specimen Collection: Venipuncture to collect serum sample; typically 5-10 mL of blood in standard serum separator tube (SST) or serum tube without additives.
- Medication Considerations: No medications need to be held; antiviral therapy (acyclovir, valacyclovir, famciclovir) does NOT interfere with IgM antibody testing and should be continued if clinically indicated.
- Patient Preparation: Arrive with empty bladder if also providing urine specimen; inform healthcare provider about current antiviral therapy; be prepared to provide detailed symptom history and timing; stay well-hydrated to facilitate blood draw.
- Timing Considerations: Best performed during acute phase of infection; early morning collection may be preferred but not required; results typically available within 24-48 hours.
How our test process works!
