[Question #5146] Ongoing 3 month illness

24 months ago
Dear Doctors, I'm hoping you could help me out with this recent stretch of ill health I'm going through. I had a possible exposure where I only noticed the condom was torn, not completely but the semen leaked out of it via some tear somewhere during vaginal hetrosexual sex with CSW. 2 weeks after I developed a weird case of tonsillitis,  chills but no fever throughout. I did a multi panel std test on the 25th day of said post exposure where I tested positive for Ureaplasma Ureatylicum, although I think I got this from my girlfriend a while back, and negative for everything else including hiv via 4th gen lab test. My tonsil and throat issues would simply not go away and I started developing an eczema like rash on my face (I've had eczema for a while but the timing was still worrying) so I tested again for HIV via 4th gen CMV and EBV specific antibodies (monospot was negative) and had a throat culture taken all on the 42nd day post exposure, Hiv test was negative and at a lower titer to that of the 25th day 0.17 on the 25th day and 0.13 on the 42nd ( probably insignificant but still made me feel good ) EBV igg was at 208.5 IGM was borderline (no other tests for EBV were done) CMV was positive at 5.6 IGG and negative IGM and my throat culture came back positive for Klebsiella species. Now I know the doctors on this board are pretty sure of the 6 week conclusive 4th gen hiv test rule, however from what I have read online, Kliebsiella infections are usually opportunistic infections. My CBC showed no reaction to the infection throughout this time, WBC count was normal but kept dropping from 7.6 to 6.8 to 6 as of this week. I took 2 day course of tinidazole and a 2 week regimen of levoflaxcin for both the ureaplasma and the Kliebsiella, and although my throat initially was back to normal within a week, I has flared up again on the 10th day of the antibiotic regimen unfortunately. Could you please help clear up why I got this Klebsiella infection?
24 months ago
I should add that I am a heavy smoker but I am only 28 years so I am not sure if that qualifies me as susceptible to a Kliebsiella infection. My questions are : 

1) Should I stop worrying about HIV amid the 42 day negative 4th gen lab test?
2) Is my 208.5 EBV IGG and borderline IGM negative and hetrophile antibody negative monospot test indicative of a past infection?
3)Am I considered immunodeficient since my body was not able to react and deal with both the ureaplasma infection and kliebsiella infection  (regular wbc with dropping wbc levels throughout the infection) I know both Dr Hook and Dr Hunter maintain that only PEP would extend the 42 day window period, however, should I continue to worry about HIV amidst my bodies inability to react to both of these bacterial infections?
4) What other STDS should I be worried about in regards to my symptoms (tonsil and throat infection)?
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to our Forum.  I'll be glad to comment and hope that my comments will be helpful to you.  the exposure you report was relatively low risk for STIs.  While it is unfortunate that your condom failed, the fact is that more CSWs do not have STIs and that most exposures to infected partners do not lead to infection.  Neither your symptoms nor your test results suggest any STI, including HIV.  Let me elaborate:

1) Should I stop worrying about HIV amid the 42 day negative 4th gen lab test?
Yes, these results are conclusive.  The symptoms you describe are not those of HIV, including the ARS which occurs in persons who recently acquired infection.  Further, HIV tests, which are amongst the most reliable trsts in all of medicine are entirely conclusive in persons who are tested at any time more than 6 weeks (42 days) after acquisition of infection.  You have ruled out any possibility that this is HIV.

2.  Is my 208.5 EBV IGG and borderline IGM negative and hetrophile antibody negative monospot test indicative of a past infection.
Yes.  This result does not suggest recent infection.  It is worth pointing out that about 25% of persons who have mono-like syndromes have infections due to CMV rather than mono.  There are likely other viral illnesses which can cause such syndromes as well.  Most persons acquire EBV in the first 5-7 years of life.

3)Am I considered immunodeficient since my body was not able to react and deal with both the ureaplasma infection and kliebsiella infection  (regular wbc with dropping wbc levels throughout the infection) I know both Dr Hook and Dr Hunter maintain that only PEP would extend the 42 day window period, however, should I continue to worry about HIV amidst my bodies inability to react to both of these bacterial infections?
I see nothing in what you have written to suggest that you are immunodeficient.  Your WBC is normal and WBC values tend to fluctuate.  Ureaplasma is a normal, colonizing bacteria present in the genital tracts of many people.  The colonization is quite difficult to eliminate with antibiotic therapy.  it is also normal.  As for the Klebsiella, this is an unusual organism to find in a person's throat but that does not mean that it is causing your symptoms or problems.  

4. What other STDS should I be worried about in regards to my symptoms (tonsil and throat infection)?
None.  From your post it does not appear that you has a direct oral exposure and your symptoms are not suggestive of an STI.  I presume that you were tested for syphilis earlier in the course of your illness but that is the only other common STI which might have caused your rash.  I suspect your current illness is not related to thee exposure you mention.

I hope that this perspective is helpful to you.  EWH
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24 months ago
Thank you for your reply doctor, I should mention there was kissing involved and that was why I suspected EBV in the first place. I just wanted to clear my conscience regarding any potential sti I might have caught during that exposure. Thank you once again.
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Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Thank you.  I understand the concern but your tests have ruled out EBV.  I'm pleased my comments were helpful.  EWH---