[Question #5190] Negative Tests but numerous symptom concerns

22 months ago

On Feb 8 I enagaged in unknown risk activities. I had too much to drink and have no recollection of what transpired in the back room of a bar but I believe there was likely unprotected anal sex (me as top). Starting 2 weeks later i had multiple symptoms including sever chills, head pressure, headaches, night sweats. I was diagnosed with a sinus infection but have since learned through xrays that it was a misdiagnosis. Was on 3 rounds of antibiotics, oral prednisone (30mg x 7days) and a nasal steroid. Have tested as follows all with duo lab tests - 17 days, 22days, 27days, 40 days, 45days. All negative. The steroids were finished 4 days before the 40 day test. I now have a facial palsy (left cheek and forehead) and peripheral neuropathy in both hands and feet - diagnosed at ER. My spouse developed a widespread rash on his torso since last week along with dry cough and significant night sweats. The ongoing symptoms are concerning despite tests. Could the steroids have affected the results? Current in remission (no medications) for crohns as well - could this affect tests? I was putting things behind me until my spouses symptoms started and now I’m feeling completely gutted. Thanks!

Edward W. Hook M.D.

22 months ago

Welcome to the Forum. I'll do my best to help. There is very, very little likelihood that you have HIV. Typically short (i.e. 1 week) courses of prednisone have no impact on the natural history of recently acquired HIV and your combination HIV antigen/antibody tests were 99+% definitive at 40 days and completely definitive at 45 days. Given the timing of your steroids, if anything they would have made the antigens tested for in your combination test more likely to be positive, not less. Further, when symptoms are due to recently acquired HIV, the tests are typically positive at the time of symptoms as well. All this leads me to be confident that you do not have HIV.

Something however is clearly going on with you- a facial palsy and peripheral neuropathy are serious problems which are worth further evaluation by a neurological specialist. Your Crohn's disease suggests that you have an element of autoimmune disease and these symptoms could be related. My advice is to not worry about HIV but to see a neurologist for your neurological problems.

Hard to determine what might be going on with your wife until there is a better idea of what is going on with you.

I hope this is helpful. This is not HIV. EWH

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22 months ago

Thanks for the reply. A few follow ups:

1- I am a MSM and the encounter would have been with a man. And my wife is actually my husband. Does this change your assessment?

2- you indicate that if anything the prednisone would make the antigen part of the test stronger. If this as an hiv2 infection and I was a late seroconverter for some reason (predinisone, crohns, weak immune system) is it not true that the 6 week test could miss the infection.

3- I have read numerous times that facial palsy and PN can and does occur in both acute and early HIV infection. If that is the case are these symptoms in the circumstances not worriesome?

4- does/can crohns in anyway affect the test?

5- my husbands symptoms are very real. He has no history of rash and it is widespread. The cough is persisting and the night sweats are soaking the sheets. He doesn’t have the same worry as me as he is not even aware of the situation I find myself in - however he is the one pointing out the symptoms so I am not simply being a hypochondriac here. He also now has an ulcer on his lip - again no history of this.

Really appreciate your time.

Edward W. Hook M.D.

22 months ago

1. Thanks for the clarification. I should not have made assumptions and apologize. That you are a MSM however does not change my assessment as relates to HIV. The symptoms you and your husband are experiencing could all be manifestations of syphilis however- were you tested. If not, I would recommend this. .

2. Of the over 40,000 cases of HIV acquired in the U.S. last year, less than 100 were HIV-2. The ARS in HIV-2 infections is not well characterized and is quite unlikely unless any potential partners were relatively recently from West Africa or India and even if from there, HIV-2 is rare.

3. I suspect you saw that on the internet. While HIV is "on the list" for completeness sake, as is peripheral neuropathy, they account for only a tiny proportion of Bell's/facial palsies, most of which have no easily diagnosed cause. If HIV of any sort was causing your symptoms, it would be extraordinary for your test not to be positive.

4. No. Crohns is an autoimmune disease. HIV can precipitate some auto-immune diseases but it should not effect the test accuracy.

5. I'm not doubting your husband's symptoms, nor yours. I would rule out syphilis if you have not. The odds of you both experiencing early HIV to lead to this collection of symptoms is extraordinarily low. OTOH, it is compatible with a non-HIV viral illness of the sort that people do get from time to time.

Thanks again for the additional information. Hope these comments are helpful. EWH

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22 months ago

Thanks again for your further response. Just a couple of things arising:

1- I have been testing for syphilis in conjunction with my HIV testing. 45 day test negative for syphilis - is this conclusive?

2 - Regarding your stats for HIV2 (ie: less than 100/40000), I note this is in the US. I am in Canada - any idea if the stats would be similar here (thinking differing immigration policies may impact?) Is HIV2 a valid concern at all or am I overthinking things here?

3- From what I understand Palsy and PN are caused by the virus itself (ie: not antibody production). Again, if this was HIV2 and I was a late seroconverter then is it not possible that the HIV2 could be causing my symptoms in the absence of antibodies?

4 - My spouse and I are in a monogamous relationship (with the obvious exception of my noted slip up). I have been very careful in regards to the activities participated in with my husband since this incident. We have had no penetrative sex however we have had oral (both ways), rimming (him to me) and masturbation (mutual). I know these are all considered low risk; however, at one point to my horror, after I finished my husband made use of my semen for lubrication for masturbation (sorry for the detail). He is uncircumcised. I know there has been a documented case via these means and given that I would have a very high viral load if I was just infected, I am completely panicked by this - especially in light of his symptoms. Is there any chance of transmission in these circumstances.

5 - your initial response indicated there is "very, very little likelihood" that I have HIV. In light of all of the circumstances, would you consider my 45 day DUO negative conclusive? Is there any realistic need for retesting and, if so, when would you recommend?

Truly appreciate the time you take to answer. Best!

Edward W. Hook M.D.

22 months ago

Thanks for the additional detail.. Straight to your questions, after which the thread will be closed as per Forum Guidelines without further answers:

1. Great. Textbook guidance suggests that it can take up to 90 days for syphilis to manifest itself but if your symptoms were due to syphilis, your syphilis blood test would absolutely be positive. You can be confident that your illness is not due to syphilis.

2. HIV-2 is certainly no more common in Canada than the U.S. and likely less so. I do think you are overthinking this. When people have HIV-2 their HIV-1 antibody tests are most often indeterminant or equivocal, not negative.

3. This is a double "what if" question about an urban myth (late seroconversion does not exist and is an internet-fueled urban myth)

4. As you point out, there may be a documented case but the reason it was worth documenting is because the event is so very rare. Getting one another's ejaculate on each other in the course of mutual masturbation should not worry you.

5. I really see no reason to retest for HIV. I DO think that you owe it to yourself to have your facial palsy and peripheral neuropathy evaluated by a neurologist or at the very least, your PMD.

I hope my comments have been helpful. I wish you the best. EWH

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22 months ago

I recognize I have had my two follow ups; however, I was just reviewing previous answers in the forum and I note that you indicate there is evidence that HIV2 seroconversion can take longer than six weeks - I know you have said that HIV2 is unlikely but can you provide me more information on this? I'm still worried in light of my symptoms and am very fearful I have infected my spouse.

Also, I have been doing some research on the effects of alcohol on the immune system and have found studies which indicate that alcohol can delay antibody production. Could this not impact the window period for the DUO test? I ask because, in all honesty, I had been drinking excessively in the weeks between my potential exposure and my 45 day test - partly because of being on vacation, partly to deal with stress - by excessively I mean passout drunk for a couple of weeks straight. I recognize I likely have a problem with alcohol at this point and I am taking steps to address (haven't drank in the last week) but is there any realistic possibility that such excessive alcohol consumption could delay the window period beyond six weeks.

Hoping you will take the time to answer this final question. With much thanks

Edward W. Hook M.D.

22 months ago

Brief answer before I close this thread. I'm saddened that you have not been able to move forward and even more saddened that it appears that you are trying to seek answers on the internet given just how much there is out of date, incorr3ect or taken out of context. HIV-2 is not well studied because it is so very, very rare. the six week guideline reflects the U.S. CDC's assessment and they have access to much unpublished, as well as published data. I suppose there could be a very few cases which may take longer but that is not the experience -please remember that package inserts and guidelines are written conservatively.

similarly, the idea that alcohol impairs the immune system enough to alter test results of tests such as the combination HIV antigen-antibody tests is a misunderstanding. It takes years of very high alcohol to impact the immune system and, even then it is a rare event.

I am confident that you are continuing to worry unnecessarily. My advice is for you to try to stay off the internet and move forward. I hope you can do that soon. EWH

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