[Question #1207] Still Very Concerned Ref: Question #1090

48 months ago
Dear Dr. Hook,

Thank you for your previous answers on question #1090.

To give you an update, I tested negative for HIV with the 4th Gen duo test both 4.5 and 7.5 weeks after possible exposure. Based on your expertise, I have moved on and do not believe I have HIV. Additionally, I had a routine physical done, which confirmed that blood, urine, lipids, etc. looked normal. 

Unfortunately, as I mentioned in my previous post, I am still suffering from chronic dry mouth and abnormal stools. I believe the dry mouth is causing my tongue to whiten towards the back. I am also feeling slight occasional neuropathy in my face and extremities. I occasionally have a throbbing pain right under my sternum near the solar plexus.

I felt a great sense of relief after getting my HIV test results. However, these persisting symptoms have kept we wondering what it could be.

1). Is is possible that these symptoms are related to HTLV I/II? Would it make sense to get tested for these?
2). Could it be a persistent EBV/CMV infection? Would it make sense to get tested for these?
3). During the oral sex act, I believe I did swallow a significant amount of vaginal fluid. Is it possible that Candida is causing my symptoms if the partner had a yeast infection?
4). Any thoughts from your side on possibilities?

I have an endoscopy scheduled for early October to investigate further. Thank you for your help.

-Dan

    
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back to the forum. Dr. Hook and I take questions at random and you have me this time. I reviewed your discussion with Dr. Hook and am pleased you are confident in your HIV test results and that you don't have HIV. Most follow-up questions like this are from people who continue to worry about HIV despite the unequivocal evidence. So I'm expecially pleased to answer these questions.

Unfortunately, the symptoms you describe are completely nonspecific. That's medical/diagnostic talk for symptoms that give virtually no clues to the cause. While some of the symptoms you describe could occur in some of the infections you describe, they also are common in literally innumerable medical conditions. They also are common physical manifestations of anxiety or stress, which can greatly magnify minor day-to-day symptoms or even normal body sensations that otherwise would not be bothersome and might not even be noticed. All human beings have periodic dry mouth, abnormal stools, and tongue whitening from time to time. As for "neuropathy", that's not a diagnosis that can be made on the basis of symptoms alone. While various things like tingling, unexplained pain, numbness, and alterted sensations can result from neuropathy, most people with these problems have other explanations. Finally, the infections you mention sometimes do include neuropathies, but there is nothing in your situation that favors those explanation.

Those comments pretty well cover your specific questions, but to be explicit to assure no misunderstanding:

1,2) HTLV I/II, CMV, or EBV are not likely explanations of what you are experiencing. You are not at elevated risk for any of them on account of the sexual exposure described. If you were my patient, I would not recommend testing for any of them.

3) There is no such thing as "systemic" candidiasis; it's an urban/internet myth. In any case, you already have (or have had) candida, which is an entirely normal yeast carried by everyone some or all the time on skin, in the intestines, etc. When people develop actual candida symptoms, it's typically not because they newly caught it, but the body's reaction to longstanding colonization. With rare exceptions, these infections are trivial inconveniences. In any case, there is nothing you would likely have acquired by oral sex on your partner, including candida, that would cause the symptoms you describe.

4) My main thought about other explanations is above, i.e. a possible emotional/psychological origin, perhaps because of anxieties about a sexual decision you regret. I am confident that no infection of any kind is the cause.

Presumably you have seen a physician about all this, right? If not, that's your next step. But don't get your hopes up for a specific diagnosis or treatment that's going to magically clera this up. In any case, I'm also confident that whatever the cause, it's nothing serious. No harm is going to come either to you or to your current or future sex partners.

I hope this has been helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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48 months ago
Dear Dr. Handsfield,

Thank you for your prompt enthusiasm in answering my questions. Your answers are clear and understood.

I did see my PCP about it and he basically said I am "healthy as a horse" and could not determine that I had been/or am sick. I asked him what he believed could be causing my soft stools and dry mouth and he too believes these could be manifestations of an underlying psychological issue/anxiety. I have been level headed my entire life, so I find a psychological topic hard to accept, however, I have not ruled it out as I definitely was paranoid about my HIV status. I also know that I get dry mouth in high anxiety situations (for example public speaking). 

What does not make much sense to me is that during the time I was sick, the dry mouth, abdominal noise/pain and irregular stool all came on very suddenly. I recall going to sleep and only hours later having a mouth that felt like the desert. Since that night most of my symptoms are gone, except for the ones I have mentioned to you today. That leads me to believe that something more acute may have been at play (rather than psychological), which may have damaged my salivary function, possibly leading to some form of IBS (it's a working hypothesis).

I visited a Gastroenterologist. I'm awaiting the results of a Pathogen test. As aforementioned, he wants to perform an endoscopy to take a look at that pain point. I am doubtful these procedures will find anything of relevance.

Thanks again for your interest in my case. I will keep you posted on how it develops.

-Dan 

  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
I really have no further comment. You're in the care of your PCP and a gastroenterology specialist. I predict they will find no specific infection or other illness to explain your symptoms, and for sure won't find anything possibly connected to your sexual exposure a few weeks ago -- that is, I also "am doubtful the procedures will find anything of relevance'. (FYI, I have no idea what a "pathogen test" is.)

There's really no need to keep me posted on what develops from here on out. I'm confident it will be nothing related to yoru sexual exposure or any infection from that event. Anything else is off topic for this forum.

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48 months ago
Dear Dr. Handsfield,

Lastly I'd like to ask you about HIV-II. My understanding is that it is predominately concentrated in West Africa. I don't believe my partner had any connection to that region, but I cannot be certain. I noticed the HIV test I took was an HIV-I Duo test. Of course, this concerns me. 

Albeit rather statistically unlikely, given my lingering symptoms, would it be prudent to rule out HIV-II through testing? Would the HIV-I Duo have turned out positive or indeterminate if I had been infected with HIV-II?

Thanks for your insight and subsequent closure of this question.

-Dan
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
HIV2 is virtually absent in North America. In any case, the tests you had detect all HIV2 infections:  your test would have been positive (not just indeterminate) if you had it. So no worries.

That completes the two follow-up comments and replies included with each new question, and so ends this thread.  Best wishes and stay safe.

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