[Question #8539] 3 month follow up testing

43 months ago

Hi Dr. Handsfield,

I’m following up to seek reassurance/advice while I wait for blood results. I asked my primary doctor to do hiv, Syphillis and herpes testing now that I’m 15+ weeks out since any potential exposure on October 3 , 2021. I know I had the 4th gen AB/AG test 36 days post exposure and it was non reactive but since it wasn’t technically 100% conclusive I decided to retest.

I’ve still been dealing with headaches, fatigue, dizziness. My wife has also been dealing with fatigue and occasional headache. I read on here someone who had similar symptoms and ended up testing positive for Syphillis. That has led me to posting while I wait for results that I probably won’t get till next week.

I have not noticed any chancres at all and I don’t believe my wife has either.

1. Could the symptoms be Syphillis?

2. Do chancres always occur during first stage?

3. Should I be worried about the result?

I tried my best to avoid coming back here but I couldn’t help but tech out after reading a post with similar symptoms and a positive result while I wait for my results,

Thanks!

Edward W. Hook M.D.

43 months ago

On this occasion, I happened to pick up your questions and will be trying to provide you with the reassurance you seek. From a scientific perspective, it is easy to reassure you that your tests for HIV and syphilis will, once again be negative. From reviewing your earlier interactions with both Dr. Handsfield and I, I do not see mention of a prior test for herpes. I worry that you will have a meaningless positive result reflecting either prior HSV-1 infections or false positivity. I certainly hope that your doctor did not order and IgM test which is specifically recommended against by virtually every expert in the field. With that, let me address your new, albeit somewhat repetitive question:

1. These symptoms are non-specific and are classical manifestations of anxiety and tension. They are included in the extensive list of syphilis symptoms which is called "The Great Imitator" because of the huge list of varied symptoms associated with this ancient disease. I remain confident that you did not get syphilis (or HIV) from the close to no risk event that set your concerns in motion.

2. In a small percent of persons with the second stage of syphilis, chancres may persist, New chancres do not appear as part of secondary syphilis.

3. You should not worry in the least about your forthcoming syphilis and HIV results. I have every confidence they will be negative and when they are, hope that you will be able to move forward. If your blood test results for HSV are positive and your doctor's explanation is insufficient, I will be happy to assist you with interpretation within the two follow-up limit for the Forum. Otherwise, I urge you not to go down the "what if" question rabbit hole

As both Dr. Handsfield and I have said repeatedly, please don't worry. EWH

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43 months ago

Thank you Dr. Hook.

Hsv2 - negative. They actually didn’t test for hsv1 which is weird.

Still pending results for HIV and Syphillis.

I’m trying not to worry about Syphillis but the fatigue, headaches and dizziness being in my wife who doesn’t know any of this and wouldn’t have the anxiety that may be causing mine are concerning. After reading the post on here with the same symptoms and that result being positive it concerns me.

With that being said:

1. Should I test again for hsv2 at 6 months?

2. We did take doxycycline back in October for 7 days - would they have cleared the Syphillis if we had? My wife did miss a pill or 2. I took all but 1. We also took azithromycin for 5 days for Covid infection we had after Christmas - could that have cleared it?

3. Should we get spinal tap?

4. I will follow up with results - hoping the other 2 are negative.

Thanks again.

Edward W. Hook M.D.

43 months ago

1. Here here test is negative. There is no need for further testing for herpes of any sort

2. Recommended therapy for Syphilis using doxycycline is to take the medication for 14 days, not seven. If you had acquired Syphilis even despite your taking seven days of doxycycline, your syphilis test results will give you a reliable indication as to whether or not you required syphilis. I am confident you did not.

3. Are you kidding? Absolutely not!

4. I perplexed that your other test results are not back yet. I am confident that they will be and look forward to hearing that they are negative from you in the not too distant future.

Once again, please don’t worry. EWH

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43 months ago

Hey Dr. Hook -

Please don’t count this as a reply as I’m still awaiting test results. I’m concerned that it’s taking long. Is this normal?

Edward W. Hook M.D.

43 months ago

I will not count this as a reply. Any further replies however will be counted. There are numerous logistical reasons why laboratories sometimes may take longer than others to report the results. Remember, the testing process involves not only obtaining the specimens but sending it to the laboratory, processing it in the laboratory, sending the results back to the clinic where the test is performed, and transcribing those results into the medical record. There are opportunities for delay at each of these steps. EWH---

43 months ago

Thank you Dr. Hook!

RPR - non reactive.

Still waiting on hiv tests and I just called my provider. They said it can take up to 7 days. Blood was drawn on 1/20. Really upset that it’s taking longer. Please don’t close this until I receive that result!

Thanks again!

43 months ago

Hiv 1 & 2 both non reactive.

Ebv still high at 103 Ebv ab vca igg

Ebv nuclear antigen ab igg 75.5

Ag ratio 2.4

Any insight here?

Thank you all for everything - seriously! I made a mistake and I know I had anxiety for sure but I can tell you what I felt was real and I still feel EXTREMELY fatigued and so does my wife (who knows nothing). I don’t want to make this a continued case. I just want to see if you have any insight to what may be causing this or the Ebv infection. I appreciate this forum as well as all of your expertise and thank you all very much!

Edward W. Hook M.D.

42 months ago

Thanks for sharing your results. Clearly you do not have HIV or syphilis Your EBV results are unlikely to be related to the encounter you are worried about. It’s time to move forward without concern. If your symptoms persist, I recommend that you work with your doctor to evaluate them but feel strongly that you have proven that they are not due to an STI of any sort. Take care. EWH ---