[Question #7628] Chronic PID

3 months ago
I had intercourse with a condom several times in 2019, last time in Mid July 2019.  In May 2019, I began to notice tender lymphnodes under my jaw...  Eventually (early Sept) nodes in my armpits, lower part of back of my head, and groin were also tender.   At that time I experienced severe night sweats and some weight loss that lasted for about 4-6 weeks.  Weight has come back and sweats have not returned.  This may be due to the EXTREME anxiety I was experiencing at that time.  Approx mid Sept 2019 my groin became inflamed from the pad above my penis to my rectum.  Urine flow and ejaculation seem reduced  and remains so to this date with occasional bouts of tickling/itching sensation in/on my anus and more seldom the tip of my penis. It also burns when I pee, but not consistently so (last 4-5 months).  Tested neg for UTI.  I also noticed abdominal bloating during this time. Between Sept and Dec I took two, 10 test panels through STDCheck.Com.  These included the HIV 1/2 ANTIGEN/ANTIBODY,4th GEN  W/RFL test, further, I had an HIV-1, Qualitative  RNA test.  All were negative.  Not tested for until recently was TRICH urine test which was neg..  Nodes remain tender in all areas to varying degrees at various times.  CT's and blood work have been done to rule out blood and other cancer concerns.  Approx. 6-8 weeks ago I had two bouts of mysterious nausea with vomiting a week apart.  No fever.  Along with the tender nodes and PDI, I recently began experiencing bloating and cramping from extreme gas.  I am feeling as if I received a false negative somewhere due to the persistent and new symptoms.  I'd appreciate your thoughts on my case.
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Welcome to the Forum and thanks for your detailed history.  I'll be glad to comment about several aspects of your situation:

1. Your exposures.  You don't say much about your past sexual partners and I'm not sure that further information would change my assessment.  Most people, even most people with risky lifestyles, do not have STIs, and even when they do, even most unprotected exposures do not lead to transmission.  In your case condoms were used and correct and consistent condom use reduces risk for most STIs to virtually zero (FYI, when condoms fail, typically they break wide open, they do not leak just a little.  If your condoms appeared intact after use, they were.  Bottom line, these were low risk exposures

2. Your tests.  STDCheck.com uses highly reliable laboratories to run its tests and the tests currently used for detection of STIs, including HIV are among the most reliable tests in all of medicine.  Your tests were performed at a time when your results, including results for HIV were entirely reliable and should be believed. They rule out STIs. 

3. Possible causes..  I do not have the advantage of examining you but I can start by assuring you that you did not get an STI, including HIV from the exposure you have described.   As for what may be going on, that's harder to say.  Not all of your symptoms may be due to a single process.  Sometimes when we start looking for signs and symptoms we start to notice things that are normal or which have been present for a long time.  Widespread lymph node swelling may result from viral infections such as mononucleosis but these problems typically resolve in a few weeks to months. The genital area discomfort is hard to assess but unlikely to be due to an STI.  When persons have tingling at the tip of the penis, this can be due to prostatitis which is virtually never due to STIs but rather results from other types of inflammation of the prostate gland,  If your urinalysis did not show signs of inflammation then it is unlikely that this is prostatitis.  Some of your symptoms also suggest the chronic pelvic pain syndrome (CPPS) which is well describe in Wikipedia and as not an STI. 

My advice is that this is almost certainly not an STI. As to what it may be, that is tougher to say. I'd suggest you work with your own doctor to continue to search for an answer.  Sometimes these things take a while to make themselves known

I hope these comments help. EWH

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3 months ago
Thank you doctor.  To clarify, the encounters were high risk in that they were with independent prostitutes.  All were protected, however, on one occasion the condom slipped off my penis after intercourse and a mix of our fluids were on and around my penis.  I may have compounded matters by attempting to clean up with an antiseptic towelette paying an inordinate amount of attention on the tip of my penis and likely forcing whatever was there into my urethra.   In any case, I also wanted to clarify that my testing took place in 2019 in a window of 2.5 months to 5.5 months after the estimated time of my last encounter and another month or two after becoming aware of the tender lymphnodes under my jaw.  In light of this new information, would your opinion be changed regarding the testing and/or need for additional testing?  Also, with regard to Trichomoniasis, would you suspect that my symptoms are consistent with a possible Trich infection? I ask because my research indicated that the urine test for Trich which I took is not particularly accurate.  If my symptoms don't fit then I won't bother with a swab test.  One last question, does the HIV-1 Qualitive test which gives me peace of mind regarding HIV-1 offer any assurances of the presence or absence of HIV-2?  If not, is there a reason that the HIV-2 Qualitive test is not as readily available under the STDCheck.Com site and I assume others?  
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago
My opinion is unchanged.  As I said earlier, even most commercial sex workers do not have STIS and your condom use reduced your risk effectively to zero.  Further as I also  your tests prove you were not infected. You were tested at a time when your test results were entirely reliable.  Test results absolutely trump any risk of an exposure.  

If your urine trich test was a nucleic acid amplification test it was the gold standard test.  I’d believe the results.  I would not pursue a swab test.

Your 4th generation HIV 1/2 test rules out HIV-2.  The PCR test does not.  FYI, only a small fraction of 1% of HIV diagnosed in North America is HIV-2 and nearly all of those infections are linked to persons from or who have traveled to West Africa or India.

I am quite confident that you do not have anSTI including HIV to account for your symptoms.  EWH 


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2 months ago
Hello doctor.  Unfortunately, while my exposure may have been minimal, I’m afraid it was more than what you have described . The prostitutes I frequented were not commercial, they were independent. 

Having the symptoms as I do, for as long as I have, (honestly they are not from hyper-awareness. For example, I can’t wear my motorcycle helmet for more than an hour without the pressure it exerts on my tender scalp nodes becoming unbearable. Furthermore, I do not enjoy sex as I did due to the discomfort I have in my testicles and penis) and now the addition of  two isolated spells of extreme gastro bloating with nausea leading to vomiting twice two weeks apart about 6 weeks ago, and now a recent reoccurrence of the same, but worse painful bloating and later a return of nausea after eating with salivating,  but no vomiting for the past week. And in addition,  the recent return of sensations I experienced earlier on such as thick mucousy, slightly scratchy throat and dry eyes have me concerned .  Further concerning me is reading that  due to people’s different immune systems, the window period for some could be many months and that symptoms can appear during the window period., thus removing my hope that symptoms meant detectable virus.
The saving grace for me and what I find myself clinging to is the Qualative test I took in mid December.  Is it reasonable for me to believe it Trumps all the other tests for HIV1?  Any other thoughts other than what’s it gonna take to make this guy relax! Thank you for your attention to and patience with me.
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

The evidence provided by your test results far outweighs the nature of your partner and associated risks.  Further, I am not doubting your symptoms or how much they trouble you.  That said, your negative test results rule out STIs including HIV as the cause of your symptoms. In addition, gastrointestinal bloating and vomiting are not STI symptoms

I can only presume that the reading you are doing is on the internet where, unfortunately much of what is said is incorrect, misinterpreted or out of date.  The idea of a highly variable and prolonged "window period" is  a widespread internet myth.  I urge you to accept and believe your test results.  believe your qualitative test results. Repeat testing is not going to change these results.  I encourage you to pursue other causes of your symptoms and not to allow your continuing concerns delay evaluation of what is actually causing your symptoms.

As you know, we provide up to 3 responses to each client's questions. This is my 3rd response. Thus the thread will be closed shortly without further responses.  EWH 

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