[Question #225] Further follow-up

36 months ago

Doctor(s):

 I previously submitted questions 188 and 199.  Unfortunately I have a few additional questions.  Since my last correspondence with Dr. Hook, I've received results from HIV, gonorrhea, chlymidia, and syphillis tests ordered by my GP 26 days after exposure.  Thankfully, all came back negative.  Unfortunately, I am continuing to show odd symptoms, with the most prominent being relatively constant dull pain in my lower back, soreness/pain in my upper abdomen (on both sides) and occasional shooting pains on my sides (above the hips).  My lower ribs on each side are also painful/sore to the touch.  I am also experiencing occasional shooting pains in my fingers and arms, though they are less prominent than several weeks ago.  I also had elevated heart rate and high blood pressure at my last exam (they are both typically low).  I am still puzzled by these conditions, and am due to see my GP again this afternoon.

Several questions:

 1.  Might I have some sort of kidney infection/issue?  The areas of pain seem consistent with a kidney issue.  Could the azithromycin or suprax have caused an issue with my kidneys?  The back pain and shooting pains started about a day after I took those medications.  Alternatively, have you heard of genitally focused anxiety or gonorrhea causing kidney issues?  Could a bacteria introduced during the exposure I had on 9/30 have caused it?

 2.  Is there any chance this is Hep B?  It is not even mentioned as a risk factor of oral sex in some places, and I believe you have both written that there have never been any confirmed cases of transmission from insertive oral sex.  Nevertheless, is there anything in my current symptoms that suggest I should test for Hep B?  Given that my back/abdominal pain started a little more than two weeks after exposure, that would seem to be too early for Hep B symptoms based on what I've read.

Thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome back. But I'm sorry to hear your concerns persist. And your anxieties are taking you well outside the STD/HIV prevention field, the only topics for this forum.

1) Despite what you assume for some reason, symptoms like yours do not suggest any sort of kidney problem. (Location alone is not a valid indicator.) And in any case, no kidney problem could possibly result from the sexual exposure you are concerned about. Whether "genitally focused" anxiety can cause this I don't know. But anxiety can certainly do things like this.

2) There is no way this is hepatitis B, which doesn't cause such symptoms and is rarely if ever transmitted by oral sex.

See a doctor if your symptoms continue to bother you, but for sure no STD is the cause; neither is any other infection from this sexual exposure. If they are connected to that event, it is psychological only.

Regards--  HHH, MD

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36 months ago
Doctor:

You seem very dismissive of the possibility of Hep B.  Perhaps you could help me understand why?

To review:  received unprotected oral sex on 9/30.  Acquired asymptomatic gonorrhea for which I was treated on 10/13.  Around 10/15, Began to experience muscle and joint aches all over my body, a sore throat, and slight fatigue.  More recently, the muscle/body aches have been far more prominent in the upper abdomen area and mid-to-lower back.  Today, I had a low grade fever and i have begun to feel nausea.

These seem to be consistent with the symptoms of acute hepatitis B (at least based on what I have read).  What am I missing that makes you conclude that there is no way this is Hepatitis?  This will be my last question; I promise.  I want nothing more than to stop thinking about this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Hepatitis B is rarely if ever transmitted by oral sex; I've never heard of a documented case.

Your symptoms are not consistent with any known STD. They sound anxiety driven as the most likely explanation. The early symptoms of hepatitis B could be similar to some of these, but that's not the right question for you to consider. The important issue is this:  given the type of exposure, the fact that the same symptoms can be caused by a hundred medical conditions you could name, and that you lack the most typical symptoms of hep B (abdominal pain, nausea, jaundice, dark urine, light colored stools, etc), what is the chance it's hepatitis B? I put it at zero for all practical purposes.

Through the two threads with Dr. Hook and now this one, you have been resistant to accepting and believing the reasoned, science based reassurance we have tried to give. This isn't a debate, and I'm not going to argue it further. It's time for you to move on. I hope you can do so.


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36 months ago
Doctor:

My blood tests came back today.  My Alt is 66, which my GP says is "slightly elevated."  He has ordered a test for acute Hep.  Does this change your view at all or should I still not worry too much about this?

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Yes, an ALT enzyme level is slightly elevated, but by itself is not likely to indicate hepatitis B; there are numerous potential causes. This doesn't change my evaluation or advice. In the off chance you have viral hepatitis of any type, it will not be from the sexual exposure you are concerned about.

That ends this thread. And please do not ask another question on the forum about this exposure or these issues. Repetative and redundant questions are not welcome, and there is nothing you can add that would change the opinions and advice you have received.

Best wishes and good luck.


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