[Question #281] Hep B testing

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102 months ago

Unfortunately, I am back again.  I apologize and ask for your patience as I don’t view these particular questions as repetitive.  I am having an extraordinarily difficult time and your expertise and advice have helped me significantly direct my care. 


Brief background - insertive oral sex on 9/30.  Tested positive for gonorrhea despite being asymptomatic (other than urinary frequency).  Took a single oral dose of suprax and azithromycin.  Soon after taking that medication began experiencing a number of weird symptoms, including fatigue, malaise, joint and muscle pain, abdominal pain particularly in the right upper quadrant, soreness all over my body (arms, shoulder blades, knees), and near constant back pain. 


It has now been almost 40 days since taking the medication and I am not getting better. At 27 and 42 days after exposure, I had HIV 4th gen duo, RPR at 27 and 42, and gon/chlym urine.  All negative.  At 34 days, PCP did a full blood and urine test, which showed slightly elevated liver enzyme (ALT of 66) and slightly high platelet count. He used the same blood draw for a full hepatitis panel (including HBsAg and HB anitbody).  I re-tested for Hep B (again for surface antigen) and C at 42 days.  All negative. 


I still feel terrible, with my most prominent symptoms back pain, abdominal pain, joint and muscle aches, and fatigue. 


A few questions:


1.  Dr. Hook once advised on MedHelp that "almost all" people will test positive for HB surface antigens within 6 weeks of infection.  Is that still true?  Relatedly, is it even possible to have Hep B-caused symptoms or an elevated ALT BEFORE testing positive for antigens?  I can't find an answer to this question but it seems unlikely given how the virus is described to work.  I want to permanently rule out Hep B.  (I know you think I already should have). 


2.  Is it possible Azithromycin or Suprax could have caused my symptoms?  My ill feeling started almost immediately after I took those medications.


3.  If someone like me presented at your clinic, where would you send him? I have an appointment with a hepatologist on Monday?


Thank you in advance for your kindness and patience.
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102 months ago
To be clear, regarding my last question - I just want to feel better, and would appreciate your guidance on where I should next turn. 
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Edward W. Hook M.D.
102 months ago

Bill.  I am not doubting that you continue to feel poorly but I am completely confident that it is not due to hepatitis B acquired through your receipt of oral sex over 6 weeks ago.  there are no reported cases of someone acquiring hepatitis B from receipt of oral sex.  The possibility is not even mentioned in textbooks and scientific articles on the disease.  As Dr. Handsfield has already mentioned, there are a huge number of other, non-STI causes of minor (and your elevations are minor) elevations in liver enzyme. These include the amount of alcohol you drink, obesity, other medications, any number of non-STI viral infection and more. 

In answer to your specific questions:

1. If hepatitis B had called your symptoms, your antigen tests would be positive at the time

2.  It is far beyond the time when the azithromycin or Suprax might cause your symptoms.

3.  If you came to my clinic with these complaints I would do the same thing I am doing here, reassure you that the enzyme levels you report are minor and non-specific and suggest observation.  I would review the possible non-STI causes of minor elevations of liver enzyme tests.

I hope this will help. You need to work to move forward from worrying about the consequences of your dalliance 6 weeks ago.  EWH