[Question #7258] HIV & Hepatits B/C

5 months ago
Hi Doctors,

I am based in the UK and foolishly visited a CSW used by an agency (who check regularly and had nothing apparently) but i am having symptoms I have never had before. I had unprotected oral and condom protected intercourse, but during oral her teeth were rubbing and caused a large bruise on the head that took 3 days to go away (no cuts that i could see).

I had a test at 31 days for everything (Private & very accurate - HIV was 4th gen) all NEGATIVE and a further test for Hep B (Antigen) at 2 months again negative. Yesterday I had a health blood test by the NHS that showed I currently have a low White blood count! I told the Dr about my hep worries but said my liver was in good shape and wasn't worried about low WBC but wants to retest in 3 months. 

symptoms:

1, Morning after very white tongue that hasn't subsided in 2 months - no sore throat
2. Jaw line discomfort and can feel lymph nodes when felt - 3 weeks now. As well as arm pit pain but that comes and goes
3. Pain in my upper abdomen and right side -  comes and goes
4. A pea sized LUMP under the skin on my penis just below the head that appeared over night - A sexual heath DR looked at it but couldn't say what it was?? Any ideas?
5. I feel very light headed, tired and weak through out the day 
6. slight discomfort in uretha but has gone now!

I took Aciclovir 400mg x3 for 5 days during the 28 day window (unnecessarily). So could that affect my test window or results? and do these symptoms suggest a serious sexual infection?

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Welcome to the Forum.  Thanks for your questions.  I’ll be glad to comment and, hopefully, to help resolve your concerns.  The exposures you describe are very low risk.  Condoms are highly effective for prevention of all STI s as long as they are worn throughout the encounter and do not break ( FYI when condoms break, they break wide open, leaving no doubt that they failed) and the STIs that you mention are not acquired through receipt of oral sex.  In addition, except for very rare transmission through receptive oral sex, hepatitis C is not sexually transmitted.  The traumatic bruising you describe does not change this.

Your 31 day test results confirm that you were not infected.  At 31 days a 4th generation HIV test would detect over 99% of recent infections as would tests for viral hepatitis.  Be confident that you were not infected.  As far as your low WBC, These counts tend to fluctuate and a low count would not be suggestive of recent infection.

Without examining you, I cannot comment on the lump the either appeared or you recently detected.  Subcutaneous cysts are not uncommon however.  The best way to have this assessed is to seek evaluation by a sexual health specialist or a urologist.

I hope these comments are helpful.  If not, please feel free to use your up to two follow up questions for clarification.EWH

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5 months ago
Thank you Dr Hook,

Your comments are very reassuring and I will disregard them, as you & Dr Hansfield say tests over rule symptoms! I am assuming the symptoms I mentioned but you did not comment on are irrelevant to std’s specifically the ones I mentioned which is great. I do however have a few questions if you’d be so kind to answer.

1. The antiviral drugs I mentioned, can they impact the tests or am I just nit picking at things that arnt a concern? 
2. The lump was examined by an std expert but she wasn’t bothered by it and did mention a boil or cyst. If it is something of that nature is there a chance it will go or are they things you have to have surgery to remove? 

Thank you once again :) 

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
You are correct, there is no reason to think that the other symptoms you describe are related to an STI.  

1.  Correct, having taken acyclovir will have no affect on test performance or the ability of tests to detect infection, if present.

2.  I would not worry about the lump.  As long as it is not growing I would not worry about it and would try to keep my hands off of it.  EWH
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5 months ago
Thank you for your insight Dr. I accept I don’t have hepatitis but I find my self rereading your post for reassurance (anxiety over the situation I assume) and I apologise if this last question is trivial but I’m curious.

Why do sexual health organisations include hepatitis C in their sexual health tests such as the NHS? 
Is it just to tick off all possibilities or is it catered for risky activities such as  men who have sex with men?

As this is my last chance to comment I thank you for your time and the service you operate. 

Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks.  I’m pleased that you found the information I’ve provided helpful and reassuring.

I can’t tell you what the thinking of the websites you’ve accessed are thinking.  I would guess however that they may worry about being wrong, even rarely.  The facts are that there are good data that for recipients of receptive rectal intercourse hepatitis C can be acquired.  Even this however is uncommon and there are not good data to inform precisely what proportion of such infections are transmitted in this way.  While I can accept that with heterosexual intercourse very rarely results in hepatitis C transmission occurs, that event is so rare  that the risk is incalculably rare.  There is no realistic reason for concern. 

Hope this helps.  Take care.  EWH
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