[Question #4431] HIV testing question and Mycoplasma Genitalium

28 months ago
Hello,

I have been on this forum a few weeks back regarding a potential exposure (Question #4121). Long story short, I have tested at week 7 (post-exposure) for syphilis and week 11 (post-exposure) for HIV (rapid finger-prick antibody test) and have all came back negative.

However, I have a few concerns regarding the accuracy of my test. Last time I forgot to mention that I have been using Over-the-Counter hayfever nasal sprays (Beclometasone Dipropionate 50mg) twice in each nosils, two times per day for the last six months, and have been taking ranitidine and lansoprazole for my stomach problems for the last three months. 

I have read that the use of steriods/corticosteriods would have an impact on the results of HIV testing, and would likely to produce a false-negative result for various reasons. I wonder if my long-term use of Beclometasone Dipropionate 50mg would invalid the result of my HIV test? If so, do I need to stop using the nasal spray and test at a later date? (and also for spyhilis?)

I have also took a urine test during the past week and unfortunately tested positive for Mycoplasma Genitalium. There is little information out there on the internet so I wonder what the treatment options would be. Is it absolutely necessary to take antibiotics? Would it eventually go away on its own? What are the consequences if left untreated?

Thank you very much for your time.

28 months ago
Just wanted to add a bit more information - sorry if this is getting a bit long.

One of the main reasons that I am still concerned with my HIV status is because I've been having ARS-like symptoms for the past three months or so. I have swollen lymph nodes in both sides of my neck, and a persistent and painful sore throat that wouldn't go away accompanied by redness in the back of my throat. I have done a swab test and was able to rule out strep throat, but the consistent pain and discomfort worries me and makes me wonder if it is related to HIV and if my test results are inaccurate due to the use of the medications.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome back to the forum. 

First, HIV/syphilis symptoms and testing:  There are no medications, illness, or health conditions that have any significant effect on the accuracy of the HIV blood tests; and probably none that affect syphilis testing either. Urban mythology worries about immunosuppressive drugs, autoimmune diseases, and other conditions. In theory, some of these might interfere with anti-HIV antibody production, but including high dose corticosteroids. However, there are no known or reported cases in which it actually happened. And even if steroids can theoretically interfere, the type and dose you are taking have absolutely no chance of doing so. Bec lomethasone is designed to not be absorbed into the bloodstream in significant amounts and can have no effect at all on the immune system. As for your symptoms, they are nonspecific -- meaning they do not point at HIV any more than at any number of other, minor medical conditions. But even if they were highly typical for HIV, the test results rule. It is not possible to have ARS symptoms without detectable antibody.

The same generally is true for syphilis. And your symptoms don't fit with syphilis either. You can be very sure you don't have it.

As for Mycoplasma genitalium, the need for treatment is not settled for men without symptoms. If you have (or in the future develop) symptoms of urethritis (discharge, sometimes with painful or uncomfortable urination), you should be treated, probably with moxifloxacin. The need for treatment in the absence of symptoms isn't established, nor do we know how long the organism might be carried. Certainly some M genitalium infections are cleared by the immune system within a few weeks, but some may persist longer.

On balance, I recommend treatment and suggest you contact the GUM clinic for their advice about it. They might recommend initial treatment with doxycycline and/or azithromycin, then retested and use moxifloxacin if it persists. However, my choice would be to just go with moxifloxacin.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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28 months ago
Dr H,

Thank you very much for your reply, your words are always reassuring.

It is a relieve to know that the nasal spray has no interference with HIV/Syphilis testing, and that I can rely on my results and move on. Thank you for the clarification.

However, my problem with M Genitalium is still a bit tricky. I visited the GUM clinic a year ago due to an irritation/itchiness inside my penis and was told that I had NGU (following a swab test that discovered blood cells in the penis). Back then the doctor suspected that it was likely M Genitalium, but could not confirm as the clinics here could only test for chlamydia and gonorrhea. Nonetheless, I was put on a 7 day course of doxycycline (twice per day) and was sent on my way. The itchiness eventually went away (and never came back), but somehow I managed to convince myself to drink alcohol during the course of treatment, which now seems like a really bad idea.

There is no certain way for me to know if I have acquired M Genitalium again recently, or if the doxycycline treatment failed to work and I had it all this time. I am assuming if it is the latter case, it would mean that I have developed resistance to doxycycline and should switch to another antibiotic? and if it haven't cleared out on its own for this long, it would be wise to start treatment as soon as possible to minimize the damage (even though I have no symptoms at all at the moment)? 

I do apologise for coming back and asking questions that you have already answered, but I tend to trust the NHS less and less these days. My last visit to the GUM clinic ended up in an argument as the 'experts' over there had never heard of a PCR RNA HIV test, and was stubborn on the window period of three months for both HIV and syphilis (world's best healthcare that is). Regardless, I'll give it another shot and let you know about their advice.

Thank you for your time.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Doxycycline often is used as initial treatment for M genitalium, but often fails -- maybe up to half the time. So persisting infection after doxycycline is common. If you were not tested for MG when your NGU was diagnosed a year ago, it is not possible to know if it was caused by MG; or, if so, whether it persisted after that event (i.e. doxy failed) or you acquired a new MG infection since then. But in view of this history, I recommend again that you be treated at this time with moxifloxacin; and then re-tested for MG in a few weeks.

I'm betting the GUM clinic will agree with this analysis. Consider printing out this thread as a framework for discussion.

Your description of the discussion about best management in the GUM clinic, I do not view that as evidence of suboptimal care or expertise. Such debates and discussions may be most common in the most expert settings. Understanding about MG and how to manage it is evolving rapidly, and discussions like this often mean that highly expert persons are still sorting out the various options.

As I think you know, threads normally are closed after two follow-up comments and replies. However, I'm going to leave this thread open so you can report the outcome after you have returned to the GUM clinic and report their reevaluation and advice. I look forward to it. But no other comments until then, OK?
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28 months ago
Dr H,

Thank you for the reply. I have just got back from the GUM clinic and have a few updates.

In short, things didn't quite turn out the way I thought it would. The doctors at first was reluctant at giving any antibiotics at all, emphasising on the 2018 UK guidelines that suggest no treatment for MG if symptoms are not present. From what I understood, they are not sure regarding the necessity for MG testing, and told me that around one percent of the population has it anyway.

In the end, I was prescribed azithromycin for three days (1g for the first day, followed up by 500 mg for two more days). The original plan was to start me off with doxycycline again for a week before azithromycin, but I had a bit of a bad reaction to doxy the last time around so was given only azithromycin instead. I have tried to suggest moxifloxacin, but was dismiss by the doctor, saying that the side effects and potential liver/kidney damages are not worth it.

I have just started my first dose of azithromycin tonight but have another question (sorry!)

As per the GUM clinic's suggestions, I was booked for a final test for HIV/Syphilis again next thursday at the 12-week mark since my exposure. I will finish the round of antibiotics on Sunday, but wonder would it have any affect on the syphilis blood test next Thursday? My concern with this is that if I have syphilis for whatever reason, will azithromycin suppress the bacteria and give me a false-negative result?

Thank you very much again for your help.




28 months ago
Another update that I forgot to mention in my post - sorry!

I have been getting white patches at the back of my throat for the last few days (the type that feels like something is in my throat when I swallow), and have been having tastes of blood in my mouth for a while. Also today I discovered that my tongue was yellow shortly after taking the antibotics. From the looks of it, it seems to match the description of oral thrush, although I am not sure why would I be getting it. 

Could this be an indication of an underlying STD (or may that be related to the more serious ones)? I apologize for all of these small questions, it's just that I have not been feeling healthy for a while and it really starting to trouble me.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
As I said above, I will have no further comments or advice unless and until you report the outcome of your (final?) visit to the GUM clinic and their advice. When you do that, they are the best ones to answer this additional question. If you post anything else before then, the thread will be closed, with no opportunity to post another question on the issues discussed here.---
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28 months ago
Dr H,

Sorry about the confusion, what I meant in my previous post is that the GUM clinic visit today is my final consultation visit. Since the clinic does not provide testing for MG, no follow-up appointments were scheduled, and I was just told to come back for the blood test next Thursday. 

I fully understand the policy of this forum, and that my final question for this thread is if the azithromycin would have any impact at all to the syphilis blood test next week.

Thank you very much for your time.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
If the GUM clinic cannot test for MG and will not prescribe moxifloxacin for it, you should connect with a provider who can do so Freedom Health is an excellent private sexual health clinic in London. Or a different GUM clinic. Or whatever clinic or doctor was involved when you had your positive test for M genitalium

Azithromycin may cure syphilis, but some strains are resistant. If your blood test remains negative despite azithro, you will know for sure you don't have it -- either you never did (which is by far the most likely probability) or it cured you after you were exposed. Either way, a negative result will prove you don't have it now.

That concludes this thread. As noted above, this will have to be your last question on these same issues, because repetetive questions are against forum policy. Thank you for your understanding. I hope the discussion has been helpful.
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