[Question #6343] Follow up to 6099 & 6144

14 months ago
Following my last exchange with Dr. Handsfield I returned to my PCP who insisted I’ve covered my bases for an std.  However the burning/pain in my penis got intense.  I visited the ER where I was diagnosed with urethritis although my mid-stream urinalysis was normal.  I saw a urologist who didn’t think anything serious was going on but agreed to do a 2nd urethral swab for HSV.  Result was negative again.  Later that evening I had mild nausea and felt like things were running wild through my head and body.  I also developed a couple of painful pimples in the fold between my butt cheek and leg.  I was reading online and became concerned about HSV2 and HIV.  I returned to the ER the following day and assured it was Folliculitis and had HIV antibody testing with negative results. They were concerned about my anxiety.   This was 21 days post exposure.  
    2 weeks later I saw a 2nd urologist who I told everything to.  My urine came back again with small leukocytes, protein 30 mg/dL (again), and trace blood-intact.  His recommendation was to give it 6 weeks and see what happens.  
    I keep getting a rash around my anus.  Nothing crusts/scabs etc.  It’s basically a redness right between the cheeks where both meet.  My wife and I resumed unprotected intercourse after getting the all clear from urologists.  She’s developed a dry cough the last month that is slowly resolving.  I have HSV and HIV blood testing scheduled in a couple days.  Questions...  How concerned should I be here?  I’ve seen 7 different doctors since this all started who have all assured me I’m fine.  Any advice/suggestions as to what I should do?  I feel like I have real concerns and all the doctors I see just want to talk about my anxiety!  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back. But unfortunately, I really can't do much at this point. With you having seen 7 doctors without clear answers, you shouldn't expect any distant source, no matter how expert -- and who cannot exmaine you personally -- to come up with answer. We cannot diagnose anything. Further, it now seems very clear that you have no STD, which is the only domain for our services:  we don't get into non STD genital symptoms. All I can do is make two suggestions:  First, that you settle on one doctor who you trust and is knowledgeable about genital symptoms -- such as one of the urologists; and second, since several of them apparnetly believe your symptoms are related to anxiety or other pyschological issue, you believe it and discuss with them what sort of counseling they might recommend.

Sorry I can't do more, but hope these comments are at least a little bit helpful. Best wishes and good luck.

HHH, MD
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14 months ago
I certainly appreciate all the advice, and have come to believe the doctors I’ve seen.  I also have an upcoming therapist appointment.  
    Since our last exchange I continue to get weird symptoms.  Sore throat, weird joint pains, and recently started getting tiny sores randomly on my body.  Including a rash just above both knees.  Nothing really itches.   The sores aren’t always on a hair follicle.  I usually don’t notice it until I go to shower.  All things I’ve never experienced til after this sexual encounter.  Questions....

How reliable is an ELISA hiv test at 3 weeks post encounter?   I asked my PCP about doing a 4th generation test now but he doesn’t think it’s necessary for some reason.  Also is there an STD besides the “normally” tested for ones I should seek out?  

I guess I’m at a loss as to what to do next.  By reading this forum and then asking questions I’m skeptical if my PCP is very knowledgeable about STDs.  I can’t imagine stress/worry is causing sores and rashes etc.  Any expertise you can offer is VERY much appreciated!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Your symptoms don't suggest HIV. Almost certainly everything you describe are trivial symptoms or normal body sensations, and skin appearances, that you would ignore or not even notice except for your anxiety, remorse, and perhaps guilt over a sexual experience you regret. There are no STDs that cause such symptoms.

That said, I see no reason you shouldn't have an HIV test. Not because it is likely you have HIV, but because anxious persons often are more reassured by negative lab tests than professional opinion, no matter how expert. (I don't take it personally!) FYI, both 3rd and 4th generation HIV tests are ELISAs. Are you sure it wasn't an AgAb (4th generation) test? If not, I can't imagine why your doctor would insist on an antibody-only test. The AgAb tests are the automatic standard these days for almost all HIV testing, especially when someone is worried about a particular exposure (because conclusive results are sooner). 

Anyway, any negative test at 3 weeks is reassuring. Around 90% of AgAb tests and 80% of 3rd gen Ab tests are positive by that time. But if you need 100% reassurance from a test, independent of my (and your doctor's) judgment, you'll need an AgAb test at 6 weeks or another Ab test at 8 weeks.
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14 months ago
You’re advice and expertise have been SO informative and I cannot thank you enough!  The medical group I use offers an app for test results, messages, questions etc.  When looking at the test results it says “ELISA antibody test”.  I don’t know what test was done.  It says average time to positive as 2 weeks.  I’m beginning to believe my PCP and others (including yourself) that stress/anxiety is a major contributor here.  If nothing else than for educational value,  I hope others read my posted questions!  This forum is unmatched in it’s real life expertise.  By reading similar posts it appears I’m certainly not alone here.  
    I’m going to go through with testing just for the positive reinforcement as you’ve and others have suggested.  Thank you from the bottom of my heart for your patience and expertise you’ve expressed!  Can’t thank you guys enough for this forum.  I’ll only return if I have a positive test result and need further clarification.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Thanks for the thanks. I'm glad to have helped.

Assuming no positive result -- and I am confident it will be negative -- this being your third question on the same exposure and related issues, it will have to be your last. Repeated questions on the same topic aren't permitted. Thanks for your understanding. Best wishes and stay safe.
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