Dear Doctor,

I am here with a new question, which is partially related to the previous one I posted last December.

After my conclusive negative HIV test, unfortunately my symptoms keep going on (dizziness, fatigue, weakness, muscles aches, chills - feeling cold all the time -, fasciculation here and there, white tongue, headache).

My doctor have run lots of tests to try and identify the origin (Complete Blood Count - for three times in one month -, hepatic function, thyroid function, EBV-CMV tests, ultra-sounds to liver-spleen-kidneys, urine test, red blood cell study at the microscope, lung X-rays): everything seems OK (just some very small traces of red blood cells in the urine, nothing to worry he says). He finally prescribed me an anti-biotic (levofloxacin), just in case. No significant improvement. Only paracetamol seems to get me temporarily better.

As you can imagine, since these symptoms started end of November, I am now extremely worried and my mood is very low (a Psychiatrist friend of my mother says it could be explained by a depression, knowing that I am very much stressed from my job and also that I have always been hypochondriac).

I discovered on the Internet that HTLV-1 could match my symptoms. The reason I am scared is that last year I had a Japanese girlfriend for a few months (she is in her early 30s, we both did STD tests and since everything was negative we stopped the use of condom: around 20 unprotected intercourses I would say). I didn't even know this virus existed and that was sexually transmitted! I asked my doctor about this and for a test, he did not really know much about it and the clinic did not even had a test for it. He also told me he thinks I should not worry about it. I am very confused!

Can you please give some your point of view? I am extremely worried. Should I? Should I get tested? Where?

Thank you very much!

There is little if any chance that you have HTLV I (or II); if you do, that you acquired it sexually; or that it is the cause of your symptoms.  Here is why:

"HTLV I could match my symptoms":  Not really. People with innumerable health conditions often complain of symptoms like yours, but don't necessarily cause them. When HTLV I/II cause symptoms at all, they are neurological but not muscle aches, weakness, fatigue, dizziness, etc); and even the neurological ones (limb weakness, numbness, tingling, erectile dysfunction, and others) are rare.

HTLV is not properly considered an STD. It may be sexually transmissible, but only rarely. One study followed 85 monogamous couples in which one or the other had HTLV I or II for 10 years. Only 4 uninfected spouses became positive themselves (in 10 years!) -- and even here, there was no evidence that they acquired it sexually as opposed to other personal or household exposures. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593454/

Third, the chance your past girlfriend had HTLV is low. The overall frequency is higher in Japan than in some countries, but still the vast majority of Japanese citizens don't have it.

Finally, you have an obvious and far more likely cause of your symptoms. It seems to me your psychiatrist acquaintance is on the right track. I'm no psychiatrist, but your list of symptoms could easily be included in basic medical school teaching about the physical manifestations of depression or other psychological factors.

So I would recommend against any further STD testing and certainly against testing for HTLV I/II. Even if positive, it wouldn't explain your symptoms. I think a wise next step would be to directly ask your primary doctor about the potential value of psychological evaluation and perhaps treatment.

I hope this has helped.  Best wishes--  HHH, MD

Concerning my symptoms, after two months I start feeling slightly better (less worse?), but still I feel constantly chilly, I sweat frequently (especially at night), I am easily exhausted, weak (especially on my arms) and the muscle of my legs (especially in the back part of both thighs) ache and feel stiff.

I will do as you recommend and have a visit with a psychiatrist; I won't further consider testing for STD/HTLV, but I will continue investigating another possible source of my symptoms with an expert in infectious diseases (should I also get in touch with a neurologist?).

Thank you very much for your help!