[Question #11762] HIV and other STI
12 months ago
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Hi Doctor, received unprotected fellatio, and
vaginal sex with condom from escort (status unknown). A month later I noticed
my eye lid swollen, accompanied by a sinus infection. Dr prescribed a ointment
for the eye and a 5 day course of amoxicillin and cortisone tablets also 5
days. (Symptoms improved).Followed by cloudy urine and burning sensation. Further
testing was done on (41 days-6 weeks) after exposure. Results were as follows:
HIV 4th Gen Elisa Negative, chlamydia lgm Positive, Hep Bs AG
Negative, HSV 2 lgg Positive, HSV2 lgm Negative, gonorrhoea PCR
(urine test) Negative, RPR negative. Not sure how I got Chlamydia I always have
vaginal sex with a Condom. I was prescribed 1g of Azithromycin for Chlamydia,
symptoms improved, shortly thereafter urine became cloudy again, further testing
detected puss in my urine and I developed prostatitis, was prescribed 14 day
course of Levofloxacin 500mg this cleared the infection. By day 52 I had some
muscle stiffness in my hamstrings and glutes, sensation very similar to stiff
muscles form exercise (faded over 3 days) a second 4th gen test at ( 56 days
post exposure) negative. Followed by a final 4th gen test (62 days - 9 weeks)negative
but still on Levofloxacin. Now 22 days remaining to full 12 weeks. Current symptoms
dry scratching throat, and a blocked nose,
with slightly swollen lymph nodes in the neck, and sensitive nodes under
my arms
12 months ago
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Questions
1, Was the testing at 6 weeks sufficient
time for other STI's? if not what should I retest? 2, Could other STI’s delay HIV
antigen/antibody production? 3, Which Sti’s are a risk oral transmission(penis
to mouth). 4, Can diabetes affect other and HIV tests 5, Can my chronic
medication affect immune response for HIV 6, Could the gene mutation or blood
donations impact immune response HIV. 7, Should I consider a 12-week 4th gen
test? Likelihood of result change in the remaining 22 days (have you
experienced any such delays or changes) 8, can my current sinus infection,
swollen lymph nodes be delayed ARS?
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H. Hunter Handsfield, MD
12 months ago
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Welcome to the forum. Thanks for your question.
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Your test results suggest you are not in the US, where chlamydia blood tests are rarely used. It's a poor test and a positive result does not necessarily mean a current infection. More on this below.
You describe a low risk sexual exposure, for several reasons: escorts (expensive female escorts by appointment) generally are low risk of having active STIs; condoms are highly effective in preventing STDs from vaginal sex; and fellatio is inherently low risk for all STIs and zero risk for some, including HIV. Your symptoms are consistent with a common non-STI virus, especially adenovirus -- which often infects the urethra and also causes conjunctivitis (your eye symptoms) and "sinus" symptoms. Adenovirus can be transmitted by oral sex, it's not an STI in the usual sense. In addition, your urinary symptoms are NOT typical for chlamydia -- but are perfect for a virus like adenovirus. On top of all this, all your symptoms started too long after the sexual exposure: I doubt that was the source. Do you also have a regular sex partner? Has she (or he) had a cold or sore throat recently?
As implied above, there is no proof you have a current chlamydial infection. It's possible, but if so, it probably wasn't from the recent sexual contact. The blood test remains positive for years (maybe for life), and could be due to a distant past infection; or a past or current respiratory infection with a related bacteria called Chlamydia pneumoniae. This poor test performance is why chlamydia blood tests are not used or recommended by most STI specialists, and little used in some countries, including the US, Australia and others. That your symptoms didn't clear up after azithromycin, or recurred promptly, is further evidence against chlamydia as the cause. On the other hand, levofloxacin is effective -- but it also treats most other causes of symptoms like yours.
For sure you do not have HIV. The exposure was no risk for HIV, your symptoms don't fit, and the HIV blood tests are proof you don't have it.
Those comments pretty well cover your specific questions, but to be explicit:
1) Your STI tests are valid except for the positive chlamydia blood test. The HSV blood tests take up to 12 weeks, so that negative result at 6 weeks isn't valid. However, your symptoms do not fit at all with herpes.
3) The main STIs transmitted oral to genital are nongonococcal urethritis (NGU) due to oral bacteria, gonorrhea, herpes due to HSV1, and syphilis. As noted above, NGU conceivably is possible, but symptoms almost always start within 7-10 days of exposure, which is why I suspect your problems are not due to ANY infection from the escort exposure several weeks earlier.
2, 5-8) No STI or any other health problem -- or diabetes -- delays or interferes with HIV test results. The HIV test results overrule all other HIV indicators: no matter how high the risk of HIV at the time of exposure, and no matter what symptoms someone has, the test results tell the truth about HIV. And your symptoms don't fit well with HIV anyway, and the sexual exposure was zero risk. It is 100% certain you do not have HIV.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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12 months ago
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Hi Dr, thank you for your very detailed response.
Yes correct I live outside of the USA, South Africa.
Thank you for more clarity on the Chlamydia testing and covering what is transmissible via oral sex all is understood in this regard.
I do have a female partner that I regularly have sex with, during the time that my eye infection occurred, she also developed a UTI, this was treated with two doses of 3g Fosfomycin and a course of Fluconazole 150 mg (This seemed effective). It was this event that prompted me to take the STI tests, as we both exhibited similar symptoms (apart from my eye). Upon receiving the lab results my GP proceeded to prescribe the Azithromycin, as a precaution this was also given to my partner (she has not had any symptoms since then 10 June). Prior to her UTI I did not notice any cold/flu like symptoms form her this could be that they were so minuscule that I missed it. Just for further clarity what do you believe the cause could have been for the tender leg muscles? note I was not on the Levofloxacin at that stage and had experienced discomfort for two and a half weeks with the prostatitis I developed). As you highlighted my 3 HIV test up to 62 days rule out any possibility of infection, my current situation dry throat and tender lymph nodes aren't doing me any favours mentally. Would you recommend further testing at 12 weeks or is it conclusive at the current situation. Also a bit worried about the 9 week incubation period for Syphilis. (is my 6 week test ok?) Thank you once again for the answers provided.
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H. Hunter Handsfield, MD
12 months ago
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Going to the last question first, for sure there is no need for further HIV testing; your negative test at 62 days is conclusive.
Although there is no way for me to be certain, it seems likely that you and your partner both had an adenovirus or similar infection; routine (i.e. bacterial) UTIs in women are not transmitted or shared with sex partners.
I'm a bit puzzled by a prostatitis diagnosis in this situation. Did you have pelvic pain or discomfort? Accurate prostatitis diagnosis is difficult, and generally requires rectal exam and other procedures. None of the possibilities discussed above, or in your partner, is a likely cause of prostatitis. I can't think how your leg muscle discomfort fits with anything else, but it doesn't sound worrisome.
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12 months ago
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Hi Dr, my GP confirmed that my urine test detected puss in the sample. I also experienced sharp and at some stages dull pain in my pelvic area and testicles. Cloudy and buring sensation when passing urine.
Do you believe my current lymph nodes swellig is a reaction from the infection two weeks ago?
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H. Hunter Handsfield, MD
12 months ago
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I can't judge the cause of the lymph node swellings -- a viral infection (other than HIV) might be most likely. Your urinary symptoms could be prostatitis, but not necessarily.
All in all, this is a rather complex situation. No online source can judge the cause(s) and potential treatment(s) of any of these problem. Keep working with your doctor. If uncertain about their expertise, consider requesting referral to an infectious diseases or perhaps STD specialist.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Good luck.
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