[Question #10700] Follow up on post PeP testing

20 months ago

Hey doc,

I was on here before with a low risk exposure and wanted to ask you something.

So about 7 weeks post PeP I had a HIV 1/2 p24 antigen test done which came out negative.

But I’m having symptoms of candida balanitis on my penis as diagnosed by my doctor. 4 days into the treatment of that with fluconazole and ciprofloxacin it still hasn’t got better.

I read that balanitis and candida is a sign of HIV and all that but my test was negative 7 weeks from last dose of pep.

Please advise on further testing or what next steps I could take for my candida.

Thank you so much

20 months ago

May I please get a reply on this

Thank you

H. Hunter Handsfield, MD

20 months ago

I'm sorry you found it necessary to return. Also sorry you didn't like waiting for a reply, but of course the forum is not staffed 24/7; new questions are answered within 24 hours.

I reviewed your recent discussion with Dr. Hook and agree with all he said. I suggest you go back and re-read it. You were at no risk of HIV and did not need PEP, and your test results prove you do not have HIV. Balanitis due to candida or other yeasts is extremely common regardless of HIV, and it would never be the only symptom of immune deficiency due to HIV.

Avoid the temptation to read lists of ARS symptoms and conclude you might have HIV just because you have one of those symptoms. Every symptom of ARS occurs far more commonly in other medical conditions; and ARS almost never has only a single symptom or problem. It is only the pattern of multiple symptoms that sometimes suggests HIV.

As for your current treatment, that your doctor prescribed both fluconazole and ciprofloxacin suggests s/he is not certain yeast is the cause; ciprofloxacin has no effect on candida. And some candida types are resistant to all the "azole" drugs. Ask your doctor about alternate treatments. Also be sure you're also using improved penile hygiene, i.e. retracting your foreskin and washing with soap and water a couple times a day. Often that's the only treatment needed for balanitis.

Do not have any more HIV tests. There is no chance you have it.

HHH, MD

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20 months ago

Excuse me for my persistence Doctor I thought maybe my question had not been posted.

Just a follow up but what would be my treatment options for balanitis?

It’s not getting better and my regimen of medicines are over. It’s just the docs here are not proficient for these kind of problems and would love some advice.

H. Hunter Handsfield, MD

20 months ago

There are several causes of balanitis. Simple accumulation of normal bacteria, dead skin cells, etc may cause it, which is why just foreskin retraction and washing often takes care of it. There are several kinds of yeasts and other fungi, including several kinds of candida -- which respond to different anti-yeast drugs. Bacterial infection also is possible. But this isn't an STD problem, and so it's beyond our expertise on this forum. When we have patients like you in our STD clinic, not responding to initial treatment, we refer them to urologists. That's what you should be doing -- seeing a urologist and following his or her advice. Good luck.---

20 months ago

Oh I had no idea about that. Thank you so much :) and thank you as always for clearing up the pep testing window worry I had.

H. Hunter Handsfield, MD

20 months ago

Thanks for the thanks. I'm glad to have helped! Best wishes and stay safe.---