[Question #8175] HIV and Reactive Arthritis

48 months ago

Hello Doctors,

I was diagnosed with Ureaplasma in July of 2020 after experiencing lower abdominal pain, testicular pain, and urethral tingling after sex with my now ex-girlfriend who I learned after my diagnosis had been with over 10 men unprotected in the year prior to me without testing for STDs. Around 3-4 weeks after the STI infection and while being treated with doxycycline, I developed ARS like symptoms that were significant including sore throat, fever, fatigue, white tongue, mouth ulcers, neck lymph nodes, and torso rash etc.

I was then tested using an Antigen-Antibody test 30 and 50 days after last sexual intercourse, both tests were negative. I tried to forget about HIV for the time being as I was told these were conclusive tests but have continued to have weird health issues for the next few months. In February about a week after receiving the 2^nd Moderna shot I got a full STD panel which included a 4^th generation HIV test which was negative and Hep C antibody test which was negative. In March 2021, I got into a new relationship and again developed STI symptoms including back pain and fatigue 1-2 days after we had sex for the first time. My current girlfriend and I have both been tested but tested negative on an STD panel so my doctor told me I may have some form of prostatitis or CPPS. 2 months after in May of 2021, I developed urethritis, eye pain, painless mouth ulcers, increased body acne, Left elbow joint pain, right hand joint pain, and right knee pain leading me to be seen by a rheumatologist. He thinks that I have reactive arthritis but had me go through a bunch of tests which involved an HIV-1 RNA PCR and 4^th generation antigen-antibody HIV test in June. Both tests were negative.

Summary:

July 2020- Ureaplasma infection

30 day and 50 day (After intercourse with ex) – Negative antigen-antibody test

6-7 months later diagnosed with possible CPPS or prostatitis after sex with new girlfriend

2 months after that diagnosed with reactive arthritis

3 months from last possible sexual intercourse or exposure had negative HIV-1 RNA PCR and repeat 4^th generation HIV Antigen-antibody test. All urine cultures and urine STD tests negative with rheumatologist.

My Questions:

1) At this time can I confirm that I am HIV negative? I have had a 4^th generation test and RNA test in June of 2021 and have not had any sexual intercourse since March of 2021. Therefore, testing was done 1 year after exposure to ex-girlfriend and 2-3 months after current girlfriend.

2) Is there any way that having covid or covid vaccination could have caused the HIV virus to mutate? Or cause a false negative even out to a year post possible exposure from my ex-girlfriend??

3) Is it possible ureaplasma can cause prostatitis or that I somehow reactivated an infection that wasn’t completely cleared? I only took 6 days of doxycycline as my doctor told me to stop taking the medication because he thought it caused my original flu like illness in august

4) My current girlfriend has been experiencing right eye redness and inflammation could it be possible that I passed her ureplasma and her body is reacting to it this way? Like what I experienced? I had a negative ureaplasma PCR test before we ever had sex.

5) Is it possible my HIV tests missed some sort of weird subtype of HIV? I currently live in New York, so I doubt I would have some weird subtype that isn’t detectable, I am mostly just afraid of a possible recombination between HIV and Sars-Cov-2 resulting in undetectable HIV.

6) From what I have read if I was an elite controller the antibody tests would still have been positive and if I was the 1 in a million seronegative-case I would have significant symptoms now and the RNA test or p24 antigen part of 4^th generation should have been positive? Am I correct?

7) My current girlfriend has developed uveitis and cold urticaria and I see these are both listed possible complications of HIV infection, I also saw reactive arthritis can occur with HIV infection? Can these be signs that I have HIV or passed HIV to my current girlfriend? Even though my tests have been negative?

8) Can reactive arthritis or autoimmune disease cause false negative HIV antigen-antibody tests or HIV-1 RNA PCR tests?

9) Should I repeat any other tests? I have also had 2 negative oral swab HIV tests and a negative finger prick HIV test done at a testing service.

H. Hunter Handsfield, MD

48 months ago

Welcome back to the forum. Thank you for your continued confidence in our services.

Your situation is complex and I will try not to second guess all that has gone before. However, like Dr. Hook, I am confident that Ureaplasma was not the cause of your initial symptoms -- but I don't think that fact is pertinent to the current problems and issues. Second, the diagnosis of reactive arthritis goes along with the urethral/prostate symptoms you report. These manifestations are part of the systemic inflammatory reaction that characterizes ReA, and usually do not reflect ongoing lower urinary tract infection with any known organism. Finally, the evidece is 100% solid that you do not have HIV.

To your specific questions:

1,2,5,6,8) Answered above. You do not have HIV. No vaccine, no other medication, and no other medical problem -- including ReA or autoimmune disease -- alters the reliability of any of the HIV tests you list, or the natural course of HIV infection. The standard tests detect all subtypes of HIV, especially in North America, Western Europe, and Australasia. Correct that the standard HIV diagnostic tests perform normally in elite controllers.

3) As implied by my comments above, I agree with your doctor that doxycycline (or any other antibiotic) is unwarranted and more likely to cause other issues -- or to confuse the main issues -- that to be beneficial in any way.

4) As discussed by Dr. Hook, Ureaplasma is a normal component of the human genital tract bacterial flora. It is not known to cause conjunctivitis. (See another comment below.) In addition, ReA is not an infectious disease and not transmitted between sex or household partners. If your partner's symptoms persist, she should seek medical care. In the statistically unlikely scenarios that she also has ReA, it will be the result of an unlikely coincidence, not a shared infection.

7) The HIV diagnostic tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results overrule all other considerations and they prove HIV isn't an issue here. At least a couple hundred other medical conditions occur with increased frequency in HIV infected people. But the vast majority of people with these conditions, including ReA, do not have HIV. Ditto for cold urticaria and uveitis. Of course if she is concerned about HIV, she should be tested. But from all you have said, I see no reason to seriously suspect she has it.

9) I can think of no other tests that you need. However, I am not your physician -- you should follow his or her advice.

Returning to no. 4 and Ureaplasma, it is a sexually transmitted. It is among many bacteria (probably including many others not yet known) that are shared between sex partners. If you think about it, you would expect almost all bacteria that naturally inhabit the genital tract to be shared between sex partners. But the fact of sexual transmission or sharing is independent of disease causation. Some shared bacteria are harmful, such as chlamydia and gonorrhea. But most are not.

Finally, in view of your medical training, I'm going to give you a mini-lecture that seems pertinent -- the emeritus professor hoping to help educate an up-and-coming young colleague. You will one day come to learn (one hopes it is included in your curriculum) that just about the worst evidence of causality of a particular health problem is the patient's conviction of the cause. Not that patients always are wrong -- of course they are not. However, a belief in a cause known to be scientifically untenable almost always is unreliable. That's why controlled trials are so important. The data that ureaplasma is a harmless component of the normal GU flora is unequivocal and not questioned by the professionals who truly understand the issues. Assuming you have a fairly typical medical career, you will encounter many patients convinced that agent X or exposure Y explain their illnesses, when you know full well that there is no evidence to support their beliefs. One of your tasks as a caring physician will be to patiently explain the truth to them, at least to an extent that dissuades them from seeking inappropriate treatment (even if you can't shake the core misunderstanding). That's sort of what I'm trying to do here!

This may be much more than you were hoping for or expectin, and apologies for the lecture. But I hope the discussion is helpful.

HHH, MD

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47 months ago

Thank you for both your reply to my questions and the lecture. It has been a very tough year of trying to figure out if I had HIV, COVID-19, or some other random viral illness that has just resulted in weird health for the past year. A lot of my issues also stem from the fact that my ex-girlfriend has refused any blood testing since she is currently in a long term relationship ~8-9 months with someone new and thinks that testing would ruin things. I luckily got her to take an oral swab HIV test at 2 months and 6 months from the last time we had intercourse which were both negative. I do have some additional questions I have thought of.

1) Do current HIV tests such as the Abbott Architect Antigen-Antibody test search for multiple antibodies to HIV-1 and HIV-2? Such as P24 antibody, GP120 and GP41? Or does it just tests for one specific antibody which is common amongst most strains of HIV?

2) HIV mutates pretty effectively, does it ever mutate so much that PCR viral load testing is no longer able to work due to PCR primers no longer recognizing HIV RNA? Or do they use multiple different primers to account for the possibility of mutations.

3) Do you have any advice for ways to help me convince my ex to get a lab based test? I have explained that plenty of people with HIV dont show symptoms early on in infection and have offered to pay multiple times for the test.

4) My original symptoms when I was diagnosed with ureaplasma via PCR testing included testicular pain, urethral tip tingling sensation, and lower abdominal pain. On urine analysis I had trace red blood cells. As both you and Dr. Hook have concluded Ureaplasma is a normal part of the bacterial flora of the GU system in both men and women is it possible it was just some other bacteria that caused an overgrowth resulting in symptoms? is the idea that some other unidentified bacteria caused my symptoms but PCR picked up ureaplasma just because it might have been slightly elevated at the time?

5) My ex-girlfriend had multiple episodes of Bacterial Vaginosis at the time, is ureaplasma connected to BV in women at all?

H. Hunter Handsfield, MD

47 months ago

1) The tests detect only a couple of antibodies, but those react consistently with virtually all HIV types and subtypes, and the p24 antigen of HIV1 is consistent across all types.

2) That has not been known to happen, at least not yet.

3) I see no reason for your partner to have any additional HIV test and I urge you to stop pressing -- this is a real turn-off for most persons, and I'll bet your partner has been telling you to suck it up and move on, 100% secure in the knowledge neither of you has HIV. When in or entering a committed relationship, most people do not insist on their partners being tested for HIV, and certainly would not request it twice and now a third time! In any case, with two negative oral fluids tests, you can be confident your partner doesn't have HIV.

4) Those past symptoms are most consistent with nonbacterial prostatitis. The cause is unknown -- probably there are several, and in fact most such cases may not be due to infection, but some sort of non-infectious inflammation. Even with complete and comprehensive testing for all proved causes, the majority of affected men have no detectable infectious cause. That Ureaplasma is present at the time does not mean it is the cause. You also said previously your symptoms cleared or improved with treatment (doxycycline?), which also says nothing about the specific cause. Ureaplasma does not have to be elevated in numbers in order for PCR to detect it. At any point in time, around 50% of sexually active persons test positive for Ureaplasma species.

5) Ureaplasma does not cause BV.

Your laser focus on HIV in the face of repeated science-based reassurance is quite abnormal. (Do you have OCD?)

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47 months ago

Yes, I am sure that I have OCD (find it hard to find a medical student without some level of OCD). My hyperfocus on HIV I think just stems from the fact that I have not felt "healthy" since being diagnosed with ureaplasma now almost 13 months ago. I have just had the worse year of health ever and in my brain for whatever reason it goes back to the illness I experienced 3-4 weeks after being diagnosed with ureaplasma.

However, I will leave this conversation knowing that if my illness 3-4 weeks after Ureaplasma diagnosis was truly HIV acute retroviral syndrome it would be impossible for me to have a negative 4th generation HIV test 5-7 days after the onset of symptoms which was confirmed with repeat 4th generation testing at 50 days, 6.5 months, 11 months, and 12.5 months now including an RNA PCR. From my understanding acute retroviral syndrome stems from both an elevated viral load and the reaction of the body (antibody generation) which would cause either the antibody, antigen, or both to be positive after experiencing symptoms. Scientifically I don't see how it could be possible to test negative on a 4th generation HIV test and RNA PCR after the window period but mentally I can't seem to get past HIV.

I think my biggest fear resolves around the fact that I feel if I had HIV I would not be allowed to continue medical school, match into a residency, or become a doctor. If someone is HIV positive can they still become a doctor? Would it be difficult finding malpractice insurance that would cover you? I think I would rest a little easier knowing that I could still live out my dream of being a doctor if I was HIV +.

Thanks for the help,

Appreciative student.

H. Hunter Handsfield, MD

47 months ago

Of course most medical students and physicians do not have OCD (which isn't the same as an ambitious personality and work ethic).

I have nothing more to say about ureaplasma and your obsession with it, except to reiterate it has nothing to do with any ongoing symptoms you have.

You do not have HIV: that you continue to worry about the possibility is a reflection of your psychological status, as is your concern about a potential impact of HIV on your career as a physician. In any case, being HIV infected has no effect on potential success or acceptance as a physician. Indeed, residency programs or hospitals granting physician privileges are forbidden by law to inquire about HIV status, which does not pose a risk to patients. So your fear is doubly irrational.

That completes the two exchanges included with each question and so ends this thread. I hope the discussion has been a little bit helpful. Best wishes in your medical education and career.

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