[Question #7737] Follow up r/t new onset low back pain

53 months ago

And here I am... back again like a crazy. Female, heterosexual 37 yo.

January- sex with new partner who was not tested as suggested we do before sex. I freaked and got the full battery of tests at 19 and 25 days, all negative, to include HIV RNA. GC totally negative, everything else as well. Was asymptomatic. In the last 2 weeks I have noted VERY bad low back pain that radiates to my pelvic area but stays right at my belt line. This is intermittent and sometimes***, but not always, alleviated with position changes. When I first wake up I am totally fine. Within an hour or two from waking it is back. It is worse with a full bladder, better after urination. (I’m very hydrated with water only). Should trich or MG be of concern? I took a 2G dose of flagyl initially and never though another thing of this until I began with these odd for me symptoms. I am asking mostly as who I need to make an appointment with? I do not want to unnecessarily clog my GYNs office, and I also do not want to tell this story to my PMD. I did a UA at work and it’s sparkling clean. Dipstick only, of course, not micro. Negative tests are negative tests, right? NAAT ever miss GC infections, though I was almost 3 weeks out? I did self treat for both trich, and GC three weeks prior to testing if that makes a difference. A vaginal DC that is creamy white, no odor, but I am ovulating so I feel that is normal at this time. The back pain is unrelenting and I’ve done absolutely nothing any different than usual, less if anything. Think this is even related to each other?

53 months ago

....and let’s add burning at the vaginal opening to the long list of other things I shouldn’t even be worrying about right now. Like I said, no further sex partners than Captain Refused to Get Tested. Wonderful. I will add again, I had the full battery of tests done through labcorps 19 and 25 days post exposure. Double to be double sure. All negative. MG and trich are the only two they left off, and I didn’t see then need as I was asymptomatic at the time. I wish him a lifetime of impotency.

H. Hunter Handsfield, MD

53 months ago

Welcome back to the forum, but I'm sorry you found it necessary.

Are you a health professional? You use terminology that suggest it -- or you've learned a lot by your (excessive?) online searching about your symptoms and STI concerns.

First and most important, there are no STIs that cause back pain. And of course back pain is one of the most common symptoms people experience -- probably nobody goes through life with no back pain problems. There is no reason at all to link it to any past sexual exposures or sexual lifestyle. That symptom has nothing at all to do with any sexual exposure and does not imply increase STI risk. If you're not seeing a physician about it, I recommend you do so -- but I assure you it has nothing to do with HIV or other STIs.

As for burning at the vaginal opening, by far the main cause is vaginal yeast infection; there are no STIs that cause this as a common symptom, including Mycoplasma genitalium or trichomonas. The same is true for discomfort associated with a full bladder or relief by urination. Clearly you have no UTI, based on the Honestly, this sounds like an anxiety related symptom. (I'm not much of a believer in anxiety or other psychological issues creating symptoms out of the blue. However, these clearly can greatly magnify trivial symptoms or even normal body sensations that otherwise would be ignored or not even noticed.)

And indeed your GC and CT NAATs are completely reliable. M. genitalium testing is not recommended without much greater suspicion -- and in any case, your symptoms do not suggest it. As for trich, even if you had it -- very unlikely without abnormal vaginal discharge with foul odor -- your excessively large dose of metronidazole would have cleared it.

Please stop your repeated STI testing and do your best to put your past sexual exposures to rest. They have nothing to do with any of the symptoms you have described. And do see a doctor about the back pain!

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---
---

53 months ago

Thank you for your kind reply! I have not excessively searched the internet, which is the one thing I steer my patients clear of. Ten year veteran ER nurse with a grad school application sitting on my desk. Thanks for noticing ;)

I am leery of any little thing at the moment, and only because they are new when I’d forgotten this even happened. I am not one to take tons of antibiotics. I am not one to take anything other than Synthroid, actually. Reluctant to take an NSAID unless I cannot stand the pain any longer. The excessively large dose of Flagly would make sense paired with a yeast infection. I did think of this, however, the discharge just doesn’t look the part. I’m not testing again, never was, but did want reassurance I could trust the NAAT vs my gun doing a cervical culture as I did test a tad earlier than I should have. I’d only briefly heard of MG and that’s been several years ago, therefore I know nothing of its prevalence or symptoms. I’ve done pelvic on women with trich, and I can assure you mine is nothing the same. But... not all are the same. My next thought, as I am autoimmune, is interstitial cystitis. This feels just like a UTI without dysuria. I’m autoimmune, they come in threes, and I am due. Or, I mysteriously injured my back and it will go away before my appointment. Either way, wanted to quadruple rule out ANY possibility of any test missing anything, as I refuse to speak these words to my PMD who is attached to my hospital system. Will treat for yeast follow up for the rest. Thank you Dr. Hansfield, stay safe out there!

H. Hunter Handsfield, MD

53 months ago

Thanks for the follow-up info. But I don't understand your statement about the large dose of Flagyl -- whether or not you had a yeast infection makes no difference in efficacy against trichomonas. Also not sure whether your comment about your gyn's NAAT testing -- did you have a trich NAAT, or are you referring to gonorrhea/chlamydia? In any case, the negative results are reliable.

Correction and apology: I was spaced out concerning your dose of metronidazole (Flagyl); 2g of course is the correct dose for trichomonas, with or without yeast infection! Sorry for any confusion.

Your possible bladder symptoms do sound potentially indicative of interstitial cystitis, but that's by no means definitive. I am unaware of any data that people with other autoimmune disorders have an increased frequency of IC, but you might have read up on this more recently or comprehensively than I have. (And of course the "come in threes" business is an urban myth!)

Most back pain is not triggered by an obvious traumatic event. It just comes on -- often with a severe initial spasm, as you've undoubtedly seen in ER patients. Of course an injury sometimes is the initial trigger, but not usually. It's just a legacy of human evolution: over the eons, vertebrate animals' spines evolved to accommodate almost entirely horizontal orientation and evolution hasn't kept up with the rapid shift (in evolutionary terms) to verticality.

Although not directly addressing your clinical questions, I'll also comment that your reticence to discuss STD related issues and sexuality with your PCP is typical. It's one of the main reasons for the importance of continued categorical STD clinics. People typically prefer both the expertise and relative anonymity of not getting STD care from the doc who manages most of their medical care. (ERs probably see more STDs than they otherwise would for the same reason.) Similar patient-doctor dynamics apply to most or all potentially stigmatizing conditions -- mental health, substance use, etc, etc.

Anyway, "quadruple rule-out" or not, I don't think you need any more STD testing.

---
---
---
---
---

53 months ago

After a weekend of feeling HORRIBLE, I’ve developed a rash on the right side of my face. Not acne, not itchy, not a cosmetic rash as I’ve used no cosmetics. No rash noted anywhere else. A dose of diflucan took care of the rest, which means it was a yeast infection. So now I’ve had a yeast infection along with feeling like I had covid over the weekend, still not feeling better, and a brand new rash on my face. Low grade fever, nothing high, terrible sore throat. All of this developed >30 days post exposure. This guy is very promiscuous I later learned. I’m getting tested for HIV again after the time has passed. I never get sick, I think I’ve had two yeast infections my entire life and never a rash on my face to my recollection. Now they are all together...

53 months ago

This is all out of Reno, NV, also, if that makes any difference in statistics.

H. Hunter Handsfield, MD

53 months ago

A cutaneous yeast infection is exceedingly unlikely; probably the rash was about to clear up anyway, not due to the fluconazole. None of your symptoms suggest a new HIV infection. Nevertheless, given your worries, it is reasonable to have another HIV blood test for reassurance. Be sure it's an antigen-antibody (AgAb, 4th generation) test. Those tests are 100% conclusive any time more than 6 weeks after the last possible exposure. They are among the most accurate diagnostic tests ever developed, for any medical condition -- and the results overrule all other considerations: no matter how high the risk of HIV at the time of exposure, and no matter how typical someone's symptoms may be for a new HIV infection, the test result rules. There are no exceptions. When you get the negative result, believe it -- then work with your doctor about other explanations for your symptoms. (Perhaps you'd like to know that in the 15 years of this and a preceding forum, also with Dr. Hook, with thousands of questions from persons concerned they had caught HIV, not a single person turned out to be infected. If and when that happens, I expect it to be a truly high risk situation, like a gay man who had unprotected anal sex with an infected partner. I'm confident you won't be the first.)

Normally threads are closed after two follow-up exchanges. However, I'll leave this open for one more. Please wait until you have the repeat HIV test result. Stay mellow in the meantime: it's going to be negative.
---
---
---
---

53 months ago

Thank you for allowing a follow up. Had I not needed to use it, I would have used it to post results later for other users. To clear up my muddy water, I will re-enter symptoms. Back pain x 2 weeks, now gone. Vaginal opening irritation, also now gone due to a dose of Diflucan last Thursday. Friday night I began with what felt like Covid/ influenza. I’ve had both, so when I say Covid or influenza, I don’t mean the sniffles, I mean a true viral illness. Headache, sore throat, extreme fatigue, nausea, low grade temp. All weekend low grade temp, fatigue and malaise that will not go away, I’ve slept more in the last 3 days than I have the last 3 months, body aches. Today, a rash on my face, but nowhere else. The sore throat is lingering, but trending better than it was three days ago. No cough or congestion or sinus issue whatsoever, no GI upset. Simply sore throat, fatigue, yeast infection last week and a rash that showed up today. The rash is only on the right side of my face and looks more dermatitis and nothing like measles or chicken pox. Honestly, it’s the fatigue that has me more concerned than anything. This is viral, not anxiety. Could be some random something in the air, not arguing that, but something is surely off. I like I have the flu in terms of energy. I WILL follow up with my PMD next week per my appointment time. I will also get tested again, after the allotted time, though I do greatly appreciate your reassurances and fully trust both the advice of you and Dr. Hook... your words really are helping me stay mellow.

H. Hunter Handsfield, MD

53 months ago

Thanks for the thanks. However, we don't advise about health issues other than STDs or HIV, and so I have no comments about other likely explanations for your symptoms. As already discussed, HIV test results overrule all symptoms, and you already had negative tests -- sufficiently long after your last sexual exposure -- to know for sure that HIV is not a possible cause of your symptoms. (It is impossible to have HIV symptoms with negative antibody test results. The symptoms of acute HIV infection are due to the immune response, not the virus itself.)

That will have to end this thread. I hope the discussion has been helpful. Best wishes and stay safe.
---
---