[Question #10244] Hiv

24 months ago

I am 27F, married (M) 12 years, both never having sexual relations until April 16. Had a threesome and invited a friend in (female,not a sex worker or drug user). He had vaginal intercourse with the both of us, 2 weeks later I started noticing discharge (bad odor/pelvic pain/body pains.) I went to clinic (17days post, May 2nd) tested neg for all STI’s/HIV 4th Gen/ Herpes blood lab test. I continued having these symptoms so I went to my gynecologists (27 days post,May 12) where she diagnosed me with acute cervicitis… At this point I had full on pelvic pain 10/10, where she then prescribed me antibiotic for 14 days. My cervicitis infection cleared but then I started experiencing extreme hip and knee pain to where it hurt & felt weak to stand/muscle spasms. Out of worry, I waited until the exact 45th day to get another full panel including HIV. On the 45th day using a 4th Gen lab test drawn from a vien, I came back negative. Since then I then started to noticed my gum line giving me pain. Ignored it, I’m now 100+ days past exposure. But still experiencing unpleasant gum line pain. Could this be an hiv symptom? My gums are burning on left side top and bottom and irritated. (Sort of looks like gum recession, white lining band around tooth) The roof of my mouth also has continuous burning sensation. I’m worried this could be something related to the sexual act since I’ve never in 27 years experienced any dental issues.

H. Hunter Handsfield, MD

24 months ago

Welcome. Thank you for your question.

I'm not sure I understand the situation. Your opening statement implies you are married but didn't have sex with your wife? Maybe you mean you and your wife had no sex with anyone except each other Then you describe a female friend in a threesome, but say "He" had vaginal intercourse with both of us. Please clarify.

Regardless of the specific relationships, onset of vaginal discharge with odor and pelvic pain are highly suggestive of a genital infection, probably sexually acquired -- which also would explain cervicitis. Testing negative for "all" STDs suggests probably no gonorrhea or chlamydia, but routine testing often doesn't include Trichomonas vaginalis or Mycoplasma genitalium, which might explain some if not all you symptoms. Also, sex can trigger bacterial vaginosis, overall the most common cause of strong vaginal odor. All that said, I'm not sure whether or how to connect all this with hip and knee pain. I also cannot explain the oral and gum pain.

Perhaps most important, for sure you do not have HIV; those test results are conclusive. It simply is not possible to have HIV with a negative AgAb (4th generation) blood test 45 days or more after acquiring the virus. In other words, the test results always overrule symptoms -- and in any case, none of the symptoms you describe is particularly suggestive of HIV.

I'm sorry I can't fully explain everything. All I can do is suggest you continue to work with your doctors. You might see consultation with an infectious diseases specialist, or perhaps a gynecologist who sub-specializes in infectious diseases. Such experts can be found at many academic medical centers.

I hope these comments are somewhat helpful. Let me know if anything isn't clear. Good luck to you.

HHH, MD

---

24 months ago

For clarity, I’m a woman - my husband and I had a threesome. Trichomonas vaginalis or Mycoplasma genitalium was also included in the 27th day testing. I need to add I have been very worried about this after the act and made my husband get a full Sti panel/Hiv 4th Gen Lab/ Herpes at (25 days post) (May 10) all negative. And He has never shown symptoms of anything this entire time. Could this be just something I’m going through? Can I fully rule HIV out being that I tested negative at the 45 days via blood lab work 4th gen? Would a infectious disease doctor tell me otherwise?

H. Hunter Handsfield, MD

24 months ago

Yes, you definitely can rule out HIV. There has never been a known case in which to took longer than 45 days for the AgAb (4th generation) HIV blood test to turn positive. In addition, it is not possible to have symptoms caused by HIV and have a negative test result. The large majority of ID specialists would agree with me.

Beyond that, I'm afraid I can't help much more. It's good your husband was tested for multiple STDs and negative, but the person who most needed testing is the other guy who made your threesome. But at this point, it seems clear that at this point, you have no continuing STD to explain your symptoms. Either there was no STD to start, or you had something undetected but that was successfully treated with the antibiotics you were given, as indicated by clearing of your cervicitis.

Sorry I can't be more helpful, but happy there's been some improvement -- and hoping your continuing symptoms also continue to improve.

---

24 months ago

The person we had a threesome with was a woman, not a man. Should I be concerned as we have no idea her hiv status other than word of mouth.

Also how accurate is lab testing? Should I be convinced that my negative result is a negative result at 45 days?

H. Hunter Handsfield, MD

24 months ago

Your opening question was worded in a confusing way. You said the new partner is female, but your next sentence was "He had vaginal intercourse with the both of us." I think I now understand you meant your husband had sex with both you and the other woman.

The lab tests done are very accurate but not perfect. Your symptoms, and their timing after that event, indeed were of concern that she had introduced an STD to your husband, and it was reasonable for you to seek medical care and STD testing, which you did. You don't say what antibiotic you were given, but between your negative test results initially and later, your health problems might have just been a coincidence. However, you do not say whether your husband or the other women were tested for STDs. That should have been done -- but if it wasn't, it would be reasonable for both of them to be examined professionally and tested for common STDs (especially gonorrhea and chlamydia) at this time. In addition, it might be reasonable for all three of you to be tested for Mycobacterium genitalium and trichomonas, as well as blood tests for HIV and syphilis, if not yet done -- just to be on the safe side.

Threads normally are closed at this point, i.e. after two follow-up questions and replies. But I'll leave it open for one more cycle in case these comments need any further clarification. If you don't mind, it would be helpful to know what antibiotic(s) you took, and also whether your husband and/or the third person have been tested and those test results.

---

24 months ago

I’m not sure on the antibiotics, for sure doxycycline and a second one either ceftriaxone or metronidazole. I can’t remember to be exact but doxycycline was indeed one of the antibiotics…both for 14 days. We no longer have contact with the other woman. My husbands sti exam was at 25 days after the act..tested was trich/chlam/syphilis, hsv type 1/2 igg, hiv 4th gen lab, gc by pcr all NEGATIVE. + no symptoms of anything. I’ve had 2 tests one on day 17 for candida, gardnerella vaginalis, trich, herpes igm/igg 1/2, syphilis, hep acute,hiv 4th gen lab, chlam/gonnorhea all negative. Another on day 45 after act, herpes 1/2 igm, hiv 4th gen lab,syphilis/Chlamydia/gonnorrhea all NEGATIVE.

24 months ago

Am I still at risk for hiv??? Herpes???? No visual signs of herpes?It’s confusing to me if it’s just me or why my husband has no symptoms of anything? And a negative result at 25 days as well… am I going through something that has nothing to do with the cervicitis infection/stds?

H. Hunter Handsfield, MD

24 months ago

Thanks for the info. It appears you were treated appropriately in view of the symptoms etc you report. If you didn't receive an injection, it wasn't ceftriaxone, but doxy + metronidazole pretty well covers every possibility. It's not ideal for gonorrhea (that's why the ceftriaxone is given), but that's fine since you tested negative for gonorrhea). I'm glad your husband was tested and negative. I'm afraid this is going to remain a mystery. The circumstances (a new sexual partnership), your symptoms and their timing all suggest an infection was introduced into your relationship. Perhaps it was all just a coincidence. On the other hand, all STD specialists occasionally see patients with such findings in the absence of any known STD. It is possible there are as yet unknown causes that explain cervicitis in women, just as the cause of almost half of nongonococcal urethritis (NGU) in men test negative for all known causes.

There is one additional possibility that I noted in my initial reply above, which you do not mention: Mycoplasma genitalium. It's a relatively newly recognized STD pathogen and not yet included in many labs' comprehensive testing panels. It might or might not explain your symptoms; it clearly causes some cases of NGU in males, but the data are conflicting (and a bit controversial) about its role in cervicitis and other genital symptoms in women. It often responds to doxycycline, and since your symptoms have resolved, I don't see a clear need to test for it at this time. However, it is an option, perhaps something to discuss with your doctor.

That will have to conclude this thread. Even though we haven't been able to discern exactly what has transpired, I do hope the discussion has been helpful. Best wishes and stay safe.

---