[Question #7623] Symptoms?

23 days ago
I should have stopped at the false positive RPR. Backstory- STD tested a month or so ago and RPR was falsely positive due to autoimmune disease. Was tested only because I was entering a new relationship and trying to be safe. Well... while I was safe, my partner was not. Only after we had sex 3 times, unprotected as we were both supposed to be tested first, do I learn he has not been tested. He is a 35 yo white heterosexual male, non drug user and fully heterosexual to my knowledge. I am a 37 yo white heterosexual female, zero history. We are 11 days post vaginal receptive sex with ejaculation and I feel “viral”. Er nurse, I’ve had Covid, so that is not it. No signs of genital HSV. My symptoms are sore throat, bad fatigue, EXTREME nausea, mild  body aches, no fever or rash of any type.  I treated for chlamydia, gonhorrea, trich without being tested because it was too early. I’m not sure if I have anything to even worry about or if I’m being ultra sensitive because I did just receive a false positive and went through one scare already while trying to do the right thing.  When discussed he just laughed it off and said the military checks all this for him. Being this is the case with his lack of testing, it has made me question his entire history. Some sites say 4 weeks for a 4th generation HIV test, you say 6 weeks. Why did this change? Thank you for your service and I am sorry I am a returning customer. Lesson learned, won’t be back. 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 days ago
Welcome back to the Forum.  I remember our prior interaction.  I suspect you may be over reacting.  I’m saddened that your partner chose not to tell the truth regarding being tested for STIs - not a very good way to start a relationship.  Indeed the military does have testing available although I’m not sure what “all the time” means.  I would have felt better if he’d told you when he was last tested.  Nonetheless, most people do not have STIs, and most exposures to infected partners do not result in transmission of infection.  Further, the antibiotics you took would have cured any common STIs.

My guess is that your flu-like symptoms are an unrelated coincidence.  Your symptoms are certainly not those of most STIs..while the are somewhat suggestive of the symptoms of recently acquired HIV, your risk is very low.  If your symptoms were due to HIV, a 4th generation test would be positive at this time.

Finally, our shift from stating that HIV test results are conclusive at 6 rather than 4 weeks was based on new data.  That said, well over 99% of persons who have recently acquired HIV will have positive tests at 4 weeks.

Hope this helps.  Please don’t worry. EWH 

22 days ago
Thank you for your follow up! I spoke with him again last night and the general consensus seems to be a “time” issue. He is a paramedic and works days and days at a time, like me, so I get it. However, he is still very evasive. Initially he did agree to to so that makes me feel a slight bit better, but his lack of follow up continues to wrack my nerves. Either way, I am left to assume he has everything, because as far as my testing is concerned, that is the drawing board I’m left on.

My symptoms, which have been her the entire time, are nausea and exhaustion. As in, I feel as if I could vomit on command and all I want to do is sleep. Food does not make the nausea better, worse actually. Sleep, when I say I slept all night and day, I am not exaggerating. None of this is typical for me. Zero fever, no rash, no vaginal symptoms, mild sore throat that lasted less than 24 hours, nothing typical of what I have read to be fearful of other than relentless nausea and exhaustion. I even took a pregnancy test that was negative, though I know it is too early. I am vaccinated for Hep B and with Gardasil. I’ve treated GC and trich. Nothing suggestive of herpes to be found. My fears now rest with HIV and Hep C, mostly HIV, but the nausea has me wondering more about hepatitis. 

Would a 4 week panel be sufficient or should I wait the full 6? 

To ease my fears and hopefully answer questions of others who may click this link that are in a similar boat of waiting our time, could you describe the early and expected symptoms of HIV? Google is terrifying, and had I found a post specific to this, it may have saved me $25. This will be my last post and question as I know you cannot diagnose me via internet with “nausea and tired”. However, your expert opinion does make waiting the next month a little easier. Thank you again for your time. 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 days ago

His evasiveness is disconcerting but it remains statistically quite unlikely that he had HIV or any other STI.  You're rightly feeling disrespected at the very least.  Your symptoms are not suggestive of any STI, including recently acquired HIV and are compatible with one of those seasonal community acquired non-STI viral infections that most people get from time to time..  Far and away the most common STIs you've been tested for are the one's you've already taken therapy for. 

Regarding further testing.  Hepatitis C is not sexually transmitted through vaginal or oral sex and is only very rarely transmitted by rectal intercourse.  I would not worry about it.  As far as HIV is concerned, testing at 4 weeks will prove that your symptoms are not due to HIV (when persons are symptomatic, their tests are always positive) and would detect over 99% of recently acquired HIV.  The remaining 1% would be detected by testing at 6 weeks after your encounters.  I would advise you to test at 4 weeks so that you can put these concerns behind you. 

The symptoms of recently acquired HIV typically occur within 2-3 weeks of exposure and are described by those who have them as "the worst flu of their lives".  A combination of severe sore throat, high fever, and muscle and or joint aches are the most typically symptoms although studies have also shown the most (again, 99%) at risk persons who seek medical for symptoms such as these do NOT have HIV. 

Finally, your experience with GOOGLE is typical and is precisely the reason we counsel against using it to sort out symptoms.  What is found there is unedited, often misleading, out of date or taken out of context.

I hope these comments are helpful.  Please don't worry.  EWH

13 days ago
In reading through the comments, I have realized your tolerance for anxiety ridden questions is zero. I will try and keep this simple and to the point, but I’m sure you will read between the lines. This is my last question of the purchase, so I will include all and any.  Feel free to yell, I  need it at the moment!

I was tested Thursday 2/11/21. I ordered both the HIV RNA (for now) and the entire battery of others, including a 4th generation ag/ab (for later). When the tech was labeling the tubes I realized she drew everything, as when I checked in at the lab the receptionist used both orders. Rather than an argument or lab confusion, I just let her do what she did, as I can always go back in six weeks as originally planned. As for now, pending in the lab is an HIV RNA and a 4th generation ag/ab. Like I said, I didn’t want the 4th generation now, that was for six weeks from now, but it’s fine as I will go back. 

For my questions: sorry this is a bit, but it’s the last time I can speak with you.

1. Timing was right and my annual pap smear is 2/16/21. I will have the NP do a full once over and probably repeat the entire slew of tests I just did Thursday... insurance will be involved here and I have no copay, so why not. Will HPV show in just 24 days with my upcoming pap? I have had gardasil, but this is for any other strain the vaccine does not cover. 

2. Accuracy of a PCR @ 19 days? Accuracy of both a combined PRC and 4th gen @ 19 days? With her doing the 4th gen at this time, is it totally useless? If both are negative, can I mosey on with life and forget this nightmare without further worry? Is a 6 week follow up still necessary? (Testing isn’t cheap). 

3. The lab is taking forever which is making me a wreck (hence the anxiety ridden questions). I used stdcheck.com which was reflexed to a Labcorps in Redding, CA. The site was incredible, and I thoroughly trust LC and Quest, they use the most modern analyzers for non-std things. However, this is taking a worrisome long time. I am concerned something is positive and they are reflexing it. I do understand it is a weekend and I do understand they are swimming in Covid-19 swabs, probably the only thing that has kept me from falling completely apart. Thoughts on testing? I used the same sit and the same lab “last time” and my results were back in 18 hours. However, there was no PCR involved and I was in Reno, a much larger city, and I went early morning vs lunch hour. The couriers may not have even picked my sample up until end of day, not sure their schedule. My biggest concern are the questions above, but if you can offer any insight on the testing methods and timeframe for the PCR, the steps with a positive, that would be great. If getting from day zero to the lab draw was horrific, waiting on results is eleven shades worse. 

As for the guy- totally MIA. When I mentioned him getting tested, I mentioned it in a very diplomatic way, as not to ruffle his ego or deter him in any way. I was not mean in any sort, nor did I repeatedly ask him to go. After I asked, I’ve yet to hear another word from him. This is all my worry. I was diplomatic, offered to pay for it, etc. I saved all my anxiety for you, Dr. Hook, none to him at all. I’m fine with him disappearing, but from me to you, this is why I am here, it worries me a lot. On the flip side, he may have viewed me as something just fun with no strings and when fun suggested he be a responsible adult, he dashed. Hopefully this is the case... 

Thank you for you presence on this site. Though I am not your patient, just knowing the ability to speak to someone with knowledge and ask questions really has made this a lot easier. There is no anxiety like this kind, trust me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
12 days ago

Thanks for your thanks. I appreciate your frustration, first with your false positive RPR test and subsequently with a partner who has been less than respectful of your wishes.  I hope that my comments have been some help and that you will be able to move forward from this trying period.  Let me remind you however that despite the frustration and anxiety you have had to deal with, there is no evidence that you have or have had an STI.  This "glass" is far more than half full. In answer to your final questions:

1.  Your HPV vaccination has markedly reduced your risk for the most common HPV types but there are over 100 different HPV types and so it is not all that uncommon to discover HPV infection despite vaccination.  That said, the non-vaccine HPV types are also less likely to progress to PAP smear abnormalities.  24 days would be a bit early for HPV to appear- most typically HPV infections become apparent in the 2-3 month range following acquisition. 

2.  Your 4th generation HIV test at 19 days will add little to what you learn from your PCR.  That said, as already discussed, your HIV risk is quite low and I have never seen a person with a negative HIV PCR more than 11 days after an exposure go on to become positive.  I anticipate that your PCR will be negative, as will the 4th generation test.  Personally, were I you, I would not feel the need for 6 week testing when your most recent tests come back negative but that, of course, is a personal decision. 

3.  I would not be concerned that your test results have taken a few days to come back.  The COVID pandemic has swamped laboratories and this is a weekend, all of which can slow down results.  In addition, as you point out, your specimens needed to be transported to the lab, then tested, then the results recorded.  All this can slow the arrival of results.   I anticipate that when you get your results, they'll be negative.

As you point out, this will be the final reply to this thread.  I hope my comments will be helpful and I hope that things will settle down for you going forward.  You are doing things right- this will keep you healthy and safe.  EWH

11 days ago
Dr. Hook, no need for any reply, this is just an update that all tests were NEGATIVE, including the RPR which is now  also negative. Autoimmune disease is so odd, it just does what it wants when it wants and I’m only certain inflammation was the original cause of a positive RPR. You were absolutely correct in all your advice. I will not retest in six weeks, there is no need. Thank you so much for your support during this unsettling time, as your services are worth their weight in gold. 

To the ones scrolling this post- listen to the experts here, do not argue with their advice, and please stay off Google as it is NOT your friend or even a good source of medical advice for STI’s or anything else. The very second I became anxious I immediately had every symptom I “though” could be related to an infectious disease: nausea, headaches, unusual sleep patterns, even a sore throat. 100% anxiety based. As you can see, my tests were negative and random symptoms benign. Please listen to the experts, they know far more than we do, and just try to breath through your time of nervousness. I hope my story helps someone else! 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 days ago
Thank you for sharing your results and for your advice to clients.  We do appreciate it.  Take care, stay well- you are doing great.  EWH