[Question #6675] History of Symptoms / Questions about HIV or other STIs

12 months ago
Hi Doctors,

Will try to make this as brief and to the point as possible, but have had a very weird history of symptoms so want to get it all out there.

Had what I believe is considered a low risk exposure (in terms of HIV) on September 20 (vaginal sex, no condom with girl I met at a bar). 9 days later I developed a sore on my penis. It was mostly painless, almost a perfect circle. My penis was also swollen. I went to the doctor that day (day 9) and they said it could be herpes but weren't sure. They tested me for gonorrhea/chlamydia urine tests, told me to come back in 2 weeks for herpes tests. Tests were negative.

Day 14
Got sick, flu like symptoms, swollen lymph nodes, fatigued. Looked at my tongue and it looked white and I freaked out about HIV, went to doctor, was tested for HSV-1, HSV-2, syphilis, HIV 4th gen. All negative. Got better after a week or two, except for white tongue and swollen penis.

Day 33
Dizziness and joint pain begins, pressure in ears, thrush (I think), bad taste in mouth, extreme fatigue, blotchy red hands. Concerned about HIV, got tested again. Duo AB/AG 4th generation test. Negative. Also tested for mono. Positive antigen indicating acute infection, but had mono at age 19 also.

Day 59
Dizziness/ear pressure, joint pain, thrush, painful lymph nodes persist. Hands are blotchy red and sweaty. See doctor again, tested for gonorrhea, chlamydia (by blood), HSV-2 IGG, HIV AG/AB, Syphilis 

It is now 5 months later and my dizziness, ear pressure, joint pain, fatigue, thrush? and sore muscles persist. Lymph nodes of armpits, neck, groin are occasionally painful. I have also had conjunctivitis and diarrhea. My penis is still swollen. Symptoms have not improved or worsened. They come and go. I have been extremely stressed throughout this period, mostly with concerns of HIV. My question for you is:

1) Are my HIV test results conclusive?
2) Based on symptoms and test history, is there any other STD that you suspect could be causing my sickness?
3) Any other ideas as to what could be causing my illness?

Thank you,
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Welcome to the forum. Thanks for your confidence in our services.

Interesting set of symptoms. My main concern is that you might have syphilis. A round, painless penile sore sounds typical for a chancre (the initial sore of syphils). Not entirely typical, because 5 days is too early -- usual onset 10-20 days. But some of your later symptoms also could be due to syphilis, such as  lymph node enlargements and perhaps continued penile swelling. The syphilis blood test you report doesn't mean much:  14 days is too soon for a positive result. So my main advice is to have another syphilis blood test ASAP. Probably it will be negative; the symptoms and timing don't line up perfectly; and heterosexually transmitted syphilis is pretty rare these days. (Most cases are in men having sex with men.) But better safe than sorry!

1) For sure you don't have HIV. Your negative HIV AgAb tests are 100% conclusive -- almost conclusive at 33 days and 100% at 59 days.

2) See above about syphilis. Otherwise, no STD causes the symptoms you describe.

3) Assuming syphilis doesn't pan out, these symptoms probably are not due to any ifnection from the sexual encounter described. Mononucleosis might be possible, especiallyw with the positive "antigen" test. This depends in part on whether you had true mono in the past. Other viruses, such as cytomegalovirus (CMV) can cause mono-like illnesses and often are sexually acquired. In addition to another syphilis test, speak with your doctor about further testing for mono, especially a Monospot test and also follow-up of the antigen (and antibody?) test(s).

Let me know if anything isn't clear, but any further substantial discussion should await the result of another syphilis blood test and perhaps additional testing to sort out the mono business. Assuming your doctor isn't an infectious diseases specialist, it might be useful to request referral to same. In the meantime, I hope these comments are helpful.

HHH, MD
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12 months ago
Hi Doctor Handsfield,

Thanks so much for your prompt reply. In an effort to fit everything in a single thread, I failed to mention that I had a negative syphilis test after 90 days. I have also recently tested negative for acute mono in a monospot test. 

I have also seen an ID doctor, who did not have any hunches and referred me back to my rheumatologist, who I will be seeing tomorrow. I'm becoming very frustrated as no one can seem to determine the cause of my illness, which is why I've come to you. 

Two last questions -

1) is it possible for someone to exhibit some or all of my symptoms due to HIV-related stress? Is this something you have seen before?
2) LGV or other rare STDs - definitely not the cause?

Thank you again for your help. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Thanks for the additional information. Syphilis, HIV, and infectious mono (due to EBV) all are solidly excluded.

Beyond that, I don't have much more to say. I genuinely appreciate your confidence in our advice and reaching out to us, but with the advice and expertise of a rheumatologist and ID specialist, there's not much more any distant online expert can add. Aside from the conditions already discussed and now excluded, there are no STDs, and no other infections you're likely to have acquired from the sexual exposure described, that can explain the symptoms you have described.

Could some of your symptoms be the result of anxiety, stress, etc? I suppose so -- some are consistent with anxiety magnifying minor symptoms or normal body sensations you otherwise would ignore or not even notice, or with heigtened perception of things like sweaty and "blotchy" hands. And of course muscle pain, discomfort in lymph node bearing sites, and so on also could fall in this category. However, if you genuinely have enlarged lymph nodes, conjunctivitis, and penile swelling (documented by your doctors), those probably are not psychological. (But I stress "documented". Your conviction frankly doesn't count if your doctors see nothing abnormal.

My guess is you have had other general tests, like complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and general chemistry panel (incluing liver and kidney function tests). What did they show?

All these are things to address with your rheumatologist and/or ID doc. But for now, I have no other suggestions and based on what you have said, I remain confident you have no infection from the sexual exposure last September.
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