[Question #3829] Dr.HH ... you fan needs help desperately !!

34 months ago
Hi Dr.HH
How you doing well. How’s the weather in Hawaii/Seattle?
I’ve been following you since Medhelp days and now here. I’ve read over 150 of your responses to people concerned about their HIV acquisition risk and HIV testing. While I’m in a desperate situation myself now, you can trust me I know your advice about 6 weeks conclusive is based on best available scientific data. I also understand that current A.G./AB tests are one of the best tests available for any medical condition.
Now Sir - my unfortunate incident 
Condone break with a high risk CSW. High risk because she offered unprotected for little extra cash. I had too many beers that day and only realised the condom ripped after I pulled out. She wasn’t bothered at all. Trust me when I say high risk please. This happened mid nov 2017.
Symptoms and Problems-
5 days later very severe itch in the area between the testicles and the anus. Lasted 30 days. Took an OTC itc cream and it resolved.
10 days post incident - flu, phlegm, body ache, rash on my neck and chest.
40 days later - pain under arms, the pain lasts till today as I type this. It is now almost 7 months.
60 days post incident - popliteal gland behind knee swells up. Swollen till date.
65 days later - oral thrush and not Diagonised by myself. It’s bad, my tongue burns and hurts. Latest till now.

Now sir - I tested for HIV with A.G./AB tests beyond 12 weeks and I know you will say that’s conclusive.
At 9 weeks I also tested for HSV 1&2 IGG - I know you say IGM useless. Also Syp/Gon/Chly all negative.
Repeated my hsv and vdrl test at 3 months and negative again.
CBC has high lymphocytes 47% and absolute lymphocyte count is also high at 3600. 
I’m really feeling unwell and very very fatigued. 
I trust your opinion. What test do I have and in your expert opinion what could have I picked up from that encounter.... something for sure 
Is there a fungal infection that I could have picked up that caused the 30 day severe itch and now is causing my oral Candida? 
Really struggl

34 months ago
Really struggling sir and need your guidance and help ...... what do you feel I shoul test for ? This oral thrush is bad. 
Thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the Forum.  As a long term follower of our work, I'm sure you know that Dr. Handsfield and I share the forum and that the content of our suggestions are interchangeable.  I happened to pick up your post today.

I won't challenge your assertion that the partner you describe was "high risk" but despite this, I will point out that most high risk persons do not have STIs and that most single encounters with infected partners do not lead to infection.  You did precisely the right thing to test as you have and I am pleased that the tests you have done are negative and I can assure you that they are conclusive.  So, what could this be.  From the sound of things and supported by your elevated lymphocyte count, you have a "mononucleosis" syndrome.  This syndrome can be caused by several different viruses, only some of which are detected by the mono spot test.  Unfortunately, when persons have this syndrome the only way to address it is with rest and time.  In some persons complete recovery can take months.

As for your thrish, this too can occur with the. Ono syndrome.  I hope you were treated with fluconazole.  If so, this should resolve that problem.

I hope these comments are helpful.  If any of this is unclear, please use your up to two followup questions to seek clarification.  EWH
34 months ago
Hi Dr. Hook,

Thank you for your advice. Yes I’ve been a long term follower of your and Dr.HH’s work. I really admire your work. 
I haven’t tested for MONO. Is Mono and EBV the same thing? I found a test called Infectious Mononucleosis panel. Is there a test for EBV as well, because then I will take both tests. As per your comments it seems that there is no treatment or medicines for mono. Is that true? Is mono known to cause oral thrush ? Except mono is there any other test you recommend? Because I will then test for all your suggestions at one go next week. Just any other STI/STD you can think of given my situation and I shall test for it. 
I’ve been so zapped with my symptoms that I just this week tested for a men’s cancer screen and got My results today. All negative. I am really grateful and thankful to you for suggesting me mono to test for as I haven’t heard of it and wouldn’t have tested for it without you suggesting it. Thank you sir. Under any circumstances I don’t want to keep asking questions and waste this golden opportunity I have with an expert like you. Please reply with any other test you suggest. I will then reply once I test next week and have my results. Once again . Thank you and have a nice day. While I write this I just wish I had physical access to experts like you and Dr. HH where I live, it would have been really really helpful. 
Please note my exposure was mid November 2017 almost 7 months earlier ... mono will last so long ? Just mentioning it in case it changes your advice. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I'm glad my comments are helpful.  About half of mono is caused by EBV but not all.  Another 20% or so is caused by CMV.  Both can be sexually acquired and irrespective of the cause, it can take quite a while to recover.  Because there is no specific treatment, while the mono syndrome can be a reason to make sure that nothing else is going on (your cancer screen was a reasonable thing to do), in most situations we do not do extensive testing as irrespective of the results, the way forward is the same-take it easy and wait.

As for thrish, it is well described in persons with mono, as well as in diabetics, persons with advanced HIV,  persons taking antibiotics for other reasons and persons receiving cancer treatment.   Most people with thrush however just get it because they have bad luck.  

Sorry there are not better answers.  I wish there were.  That said, I encourage you to try to wait this out unless your own doctor has other thoughts and to not overthink this.  EWH
33 months ago
Hi Dr. Hook,

After you suggestions and further testing I’m now confused. As you advices that what I may be suffering from can be Mononucleosis which is sometimes caused by EBV or CMV.

I went through a series of tests. CMV showed past infection as mentioned in my test results. The EBV results are confusing me now. In the Mononucleosis Panel I got a negative for EBV - CA IGM, Positive For EBV (VCA) UREA, positive for EBV (VCA) IGG, Negative for EBV - EA IGG, positive for EBV -NA IGG. The EBV (VCA) IGG said positive (+++), which I think means high amount of antibody. 
I’ve been suffering from the past 7 months, my exposure was 7 months back. Then I went and got separate tests done and below were the results. These tests were over and above the Mononucleosis panel.
EBV (NA) IGM antibody - negative (1.78)
EBV (EA) - IGG antibodies to early antigen of EBV - Equivoval (36.6)
EBV IGM (VCA) - Negative 
EBV (VCA) - IGG Antibody to viral capsid - positive ( 101) - negative is under 20 and positive is above 20.

I also got a EBV quantitative PCR - DNA viral load with a result of Below 100 copies/ml. 

With all these results now I’m confused and need a our expertise. Do I have an active EBV infection .... my antibody level of EBV VCA seems very high... is that normal .... please note it’s been 7 months since my exposure .... I have now started getting a severe muscle twitch in my right arm ( biceps). It’s quite severe and annoying as if I’m losing control on that arm/ muscle. 
I have done my best to be patient and go through all testing and then come back to you with results so that you can guide me in the right direction. 
Once you give me your advice please don’t close this thread and as per forum rules if you have to I will need to start another one hoping that questions comes to you because I want to reach a solution. What is wrong with me ??? I’ve been through enough testing now. Does this viral load of below 100 copies/ml means that I don’t have EBV and none of this is being caused by EBV? Is it normal to have such a high level of antibody of EBV VCA? Why is it in the panel the EBV EA IGG came negative and as a stand alone test the EBV EA IGG came equivocal ? Please help me understand these results ... is it and ongoing infection or a past infection ? What do I do further ? How do I move ahead? Should I test for something else? Need your expertise desperately now. Please help me out Dr. Hook. Thank you !! 
33 months ago
I would like to add that I also got tested for Lyme and Adenovirus ... both negative ... 
very important my Liver function test I got a very high LDH. Normal range for LDH was 125-220 and mine is 403. Can EBV cause the LDH to be so high if you think that I have/had EBV. 
33 months ago

33 months ago

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
You are over reacting.  Take a deep breath and relax.  Your tests show that you have had EBV and are compatible with a past infection which is resolving slowly.  There is NO evidence of active EBV infection. 

Your results are not alarming and are completely compatible with a mononucleosis syndrome which is slow to ressolve.  As you will note above, because there is no therapy for mononucleosis syndrome or EBV infection, I told you  "...in most situations we do not do extensive testing as irrespective of the results, the way forward is the same-take it easy and wait."  Your laboratory results indicate that you have had an EBV infection, that it is not acute or ongoing.  Your LDH tests are likewise not alarming and being only twice normal are not a concern and warrant no evaluation other than watchful waiting and perhaps another LDH test in 6 months or so.  A worrisome liver enzyme test is tens of times higher than the upper limit of normal, nor twice normal. 

Your muscle twitching is unrelated to your past EBV infection or the sexual encounter you described.  it is suggestive of anxiety. 

I'm sorry you did not take my initial advice.  As per Forum rules, this thread will be closed later today and there will be no further replies from me.  Your anxiety is getting the best of you. Further testing is a waste of the time and, I suspect, the considerable amount of money you have already spent on testing for something that you can do nothing about but wait.  I hope you will do that.  EWH