[Question #1235] symptoms for 10 weeks and negative testing, after possible exposure

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90 months ago
almost 11 weeks ago i visited a ts escort first time and was encouraged to try recieving anal. I had never done that before. The person took out a condom and got behind me but after about 4 or 5 min i noticed it wasnt being used. I stopped the encounter upset and left. First time trying that and never had any hetero sex or anything else before unprotected. I left a question to dr hook a little over a month ago he told me to test.
I have had symptoms starting a week after exposure of cognitive issues that came and went. i had slight nausea. After about 5 weeks it lessened and i had abdominal pain on the right side but also it was transient and began to feel worse and bloat.   If i ate even a little i felt really full a I took a oraquick oral hiv test at week 9 and it was negative. I got orders for a blood std testing and took it at week 9.5 it came back 
negative hiv1/2 with a 4th generation antigen / antibody
negative hepatitis b and c
negative syphillis
negative gonorhea
negative chlymadia.

I mentioned to a urgent care doctor what i had done and he said the tests are negative but there was no swab so i will give you
1000mg azithromycin on saturday
1000mg arithromycin on sunday 
400 mg suprax on monday
this will cover you for std because a swab wasnt done
taking the antibiotic did help some and my abdominal bload and pain was mostly gone, but i do still have some abdominal pain and am getting the occasional head waves again where i feel bad.
This comes and goes during the day and can have minor nausea for a few seconds at times.
1.Could my negative hiv test be wrong with a 4th generation at 9,5 weeks after exposure?
2. Could the experience have caused stomach or abdominal cancer that fast after one time experience?
3. why are my symptoms now lasting almost 10 weeks and 11 weeks after the possible exposure?
It comes and goes during the day, i feel ok for a while and then can feel not too well at all

4. Should the antibiotic have killed any std?
5. would i need to test again at 12 weeks?
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H. Hunter Handsfield, MD
90 months ago
Welcome back to the forum.

I reviewed your discussion a few weeks ago with Dr. Hook and agree with all he said. Although we understand your concern, and even though you had a potentially very high risk exposure (unprotected receptive anal sex with a transsexual but anatomically male partner), for sure you were not infected. The evidence now, with your additional test results, is even more conclusive than a month ago.

Your symptoms do not fit with any STD. HIV can cause some of the symptoms you have experenced, but so can a hundred other conditions, including the physical manifestations of anxiety or stress -- which is a likely explanation in your case. Most important, HIV tests always overrule exposure history and symptoms, as long as testing is done sufficiently long after the last possible exposure. That interval is 4 weeks for the 4th generation blood test, so your negative results are 100% conclusive. Whatever is causing your symptoms, it isn't HIV.

The other tests you had also are highly reliable and are conclusive at the times you were tested. For sure that's the case for hepatitis B and C and for syphilis, and in any case these also are not likely explanations for your symptoms. For gonorrhea and chlamydia, I presume you had rectal swab testing. There are no reliable blood tests for those infections. But these too would not cause any of the symptoms you describe.

Those comments address most of your questions, but to be explicit so there is no misunderstanding:

1) It is not possible to have HIV and have these negative test results. You don't have HIV.

2) Stomach or abdominal cancer do not cause symptoms like yours, and in any case there is no STD that causes such cancers. Even if that were somehow connected with the sexual exposure, it takes many years for cancers to develop, not a matter of weeks.

3) Your symptoms probably are continuing for the reason I suggested above: You probably are experiencing the physical manifestations of anxiety over the sexual experience.

4) Had I been your doctor, I would not have treated you with these or any other antibiotics. I have to suspect the urgent care doc gave them to you primarily for reassurance, not because he actually thought you were infected. However, they probably did no harm. They were not the recommended doses, but they would have aborted or cured gonorrhea, chlamydia, or syphilis if you had any of them.

5) There is no need for any further testing.

Do your best to compartmentalize your thinking and your fears, i.e. separate 1) your reaction to the surprise of the sexual exposure and your regret over it from 2) HIV/STD risk and symptoms. Deal with the first as you need to, but do your best to stop worrying about infection. You didn't catch anything. If your symptoms persist, see your personal physician (or find one, not an urgent care clinic) for comprehensive medical evaluation. As discussed, you can expect that no infection of any kind will be found, at least none that is related to the sexual exposure.

I hope this has helped you put things in perspective and move on with your life. But let me know if anything isn't clear.

Best wishes--  HHH, MD

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90 months ago
Thank you Doctor Handsfield for responding. When the lab did the gonnorhea and chlymidia test the did it by testing the urine. I told the urgent care doctor that it was an anal exposure and thats why he perscribed the azithromycin and suprax. Even with them not testing on those correctly would the antibiotic surely have knocked those out?  I still have some abdominal pain that does refer to the back. I  feel it must be something because it occurred exactly one week after the incident and the medication did help decently but not entirely. I will follow up with a primary care doctor as you recommend.
1. Could there be any other std i could have contracted that the lab didnt test for?
2.You mentioned the medication was not really the correct dosage for those stds, but would it have surely knocked them out anyway with incorrect doses(chlamydia and gonorrhea)?
thank you again, i was worried because of the risk i may need to test at 12 weeks but if you say the 9 week oral swab and 9.5 week 4th generation lab blood hiv test are conclusive i will go with your many years of experience and not test again.
Have you ever heard of a 9+ week 4th generation negative ever becoming positive?
thank you again for all your responses
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H. Hunter Handsfield, MD
90 months ago
Hard to know what your urgent care doc was thinking. Gonorrhea and chlamydia don't travel through the body to be detected at places other than where the infection starts. A rectal exposure cannot result in urethral infection and of course cannot be detected by urine testing. I don't necessarily expect you to have known this, but the doctor certainly should have known! Why in heaven's name didn't he do a rectal test?

Otherwise, you are asking questions already answered, in slightly different words, and I haven't changed my mind. 1) No; re-read above. 2) Yes. 3) A negative 9 week 4th gen test never becomes positive later. Four weeks is all it take, period.

You're pretty obviously still very emotional about this. But you have a responsibility (to yourself) to think clearly and critically about all this. Re-read all my comments above and do your best to move on.

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90 months ago
doctor i want to ask one more thing. If this was gonorhea or chlymadia and he didnt swab for a conclusive, could of they moved to the stomach or intestinal tract because they were not treated for almost 10 weeks? (and he did a urine test)
Also i am planning to go to our family primary care physician and dont want her to really know about this issue. I am going because of now 10 weeks of on and off abdominal pain and bursts of feeling of nausea and weird head waves.   
I dont want to mention any of this to her, so would it be safe if she is asking questions and taking a history to not mention this incident to her at all and assume any std or infection related to the encounter would not show up or have any bearing on how she goes about diagnosing my 10 week symptoms? I dont want to mislead but want to omit what happened if there is really now no reason to bring it up to her
thank you again for all your help
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H. Hunter Handsfield, MD
90 months ago
See my reply above about these infections not moving through the body. Your negative urine test is absolutely meaningless in judging whether or not you caught gonorrhea or chlamydia.

Very good plan to see your personal physician about your symptoms. But never give less than complete information and medical history to your family doctor. She will be more understanding than you fear, and will keep all information strictly confidential from other family members. Even though there is no chance your symptoms are related to the sexual exposure, you obviously are obsessed and anxious about it and she should be made aware. In addition, undoubtedly she will also reassure you that the symptoms are unrelated, just as I have tried to do. That reassurance should be very helpful to you. In other words, there really is good reason to "bring it up with her", even though it is not a plausible cause of your symptoms.

Normally theads are closed after two follow-up comments and replies. However, I'm going to leave this open in the hope you'll return with a final comment after you have seen your doctor, preferably giving her the complete story. But please no other additonal comments until then; I won't have anything more to say unless and until you report the outcome of your doctor visit. Good luck with it!