HIV - Prevention Expert Forum
Can I have advanced case but negative tests?
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Can I have advanced case but negative tests?


Dear doctor, I hope you can give me some insight on my status. It all started ~15 years ago. I got married but became unfaithful(I know I'm a *******) and had sex with csw. I never tested for std until around 5 years ago(spec HIV neg). Around 4 yrs ago I started having health issues which continue to this day.  NOTE: MY LAST EXPOSURE 4 years ago. These include whitish tongue, VERY easy bruising, chronic sore throat,muscle weakness,BAD muscle twitch on all parts of body, BAD joint pain of wrists and ankles,and BAD floating rods that what I render, are fungal floaters in vision. I saw doctor about eyes and he didnt see anything much. So 3 years ago I started testing for HIV/std up until now. I'll give you the latest which were this past yr.  HIV 1/2 duo, HIV-1 RNA & DNA, HIV-2 DNA,hiv 1/2 antibody by quest and labcorp, oraquick, chlamydia, gonorhea, syphilis(RPR,FTA-ABS,TP antibodies,TPPA).  ALL of the tests have been negative.  1) being that I didn't start testing for yrs after 1st exposure, could I have a case of ADVANCED HIV disease that is not detectable with my tests? 2) is there atypical HIV that could be missed, like a strange group, crf, subtype? 3) I heard that some pcr tests won't find HIV-2 or odd strains, true? 4)could I be missing syphilis of some stage(advanced latent or neuro) that is being missed by both the non-trep, and trep tests?  Is that possible? 5)is there anyway I could have given anything(std) to my wife and kids as they tend to be more ill over the past year? 6)if I test neg on all tests, but would in fact for some reason would be HIV/syphilis positive, wouldn't if I suggested(which I don't want to do If I don't have to) them getting tested, that the tests would fail to pick them up too?  I just want to get back to a healthy person and the physical problems are preventing that. Is there any better testing to do? Any insight would be great. Thank you
300980_tn?1194933000
Welcome to the Forum.  Sometimes Dr. Handsfield composes an initial response to clients even before he reads their questions, based on the title of their post.  I think I'll try that approach here.  We all too commonly get questions from persons worried that they might have HIV or other STDs either based on continuing non-specific symptoms or other concerns despite the facts that they have had little in the way of risky exposures and, typically, multiple negative tests.  Despite the fact that each of us on this Forum are scientists who have spent our careers challenging misperceptions and incorrect beliefs, the fact is that we have never supported the idea of any of the hundreds of clients who have asked these questions.  The reasons for this are several and include that currently available tests for HIV are amongst the most sensitive of tests in all of medicine and that they virtually never miss infections among infected persons, even when they are infected by less common HIV strains.  The myths of HIV test inaccuracy are one of the best examples I know of the sort of harm that internet-fueled misperceptions can do.  The signs and symptoms of HIV are, by and large, non-specific and when person have persisting symptoms in the face of negative tests, the problem is virtually never with the test but with the fact that the symptoms are caused by something other than HIV.  Having said this, I will now read your question.

Well, I see that I did anticipate you questions.  You need to believe your tests and look for alternate explanations for your symptoms.  The symptoms you mention are truly non-specific and some of them, such as joint paints are not typical of HIV or, for that matter any other STD.  My sincere advice is to stop wasting your time and money in the service of your guilt over your infidelity to you wife and instead seek evaluation by a trained clinician, such as an internal medicine specialist, who can evaluate you thoroughly for other causes of your symptoms.  

Please believe me, I am not playing games with you and I do believe that you have the problems you mention above.  At the same time however, I am confident that you should believe your test results and not worry about STDs or HIV as their cause.  I hope my comments are helpful to you.

EWH
10 Comments
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Avatar_m_tn
Thank you so much for answering. I guess I'm just so worried that for some reason the tests that I've had could be falsely negative and I'm putting others(wife, if not already),in harms way. I just don't see what else I could do in terms of additional testing to rule it out without a shadow of doubt. I know you didn't elaborate, but regarding those questions:  remember that my last exposure was four years ago but others prior to that
1)Could a person have HIV for say years, and not show positive on antibody test or detectable on pcr tests,thus being false neg?(serorevert)
2)without treatment would antibody test always be positive, or RNA detectable)
3)how about syphilis tests?  Can you have all hose tests be negative, but still have syphilis?
4)is there any other test to do that would be better at conclusively ruling these two processes out?
5)is it possible that either HIV or syphilis is missed by all these tests?

I just have to make ABSOLUTELY SURE that this isn't either of these. I'm working with my doctors, and they verify by physical ailments, but say tests are neg.
Thank you
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300980_tn?1194933000
Sigh- you apparently did not read my reply very well.  There is simply no way this is HIV or other STD.  You need to look for another explanation, something that I told you to do as well.

As for your repetitive, anxiety and guilt-driven questions:
1)Could a person have HIV for say years, and not show positive on antibody test or detectable on pcr tests,thus being false neg?(serorevert).
NO!!!

2)without treatment would antibody test always be positive, or RNA detectable)
Yes.

3)how about syphilis tests?  Can you have all hose tests be negative, but still have syphilis?
No, not in your situation.

4)is there any other test to do that would be better at conclusively ruling these two processes out?
Further testing is a COMPLETE WASTE OF TIME AND MONEY.

5)is it possible that either HIV or syphilis is missed by all these tests?
NO!!!!!!

EWH

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Avatar_m_tn
Dr Hook,
Thank you for your responses earlier. They are well appreciated. I will work closely with my primary and switch internist to figure things out. Most of my testing has been done through online testing sites that use quest and labcorp if that makes any difference. I would like to end this thread and if you could answer/expand on a few questions I would really appreciate it.
1) In regards to syphilis, you mentioned in "my situation".  But as a general rule, could you have syphilis past/present with repeated rpr, FTA-abs, tppa, EIA?  Meaning I guess, are there limitations to the tests that all could show negative even in presence of infection?
2)you really cannot miss HIV infection with today's tests that available? Especially with the ones that I have had?
3) does it ever present a diagnostic dilemma with HIV and symptoms, when all tests are negative, or do tests always rule?  
4)is there ever any advantage to testing for these two diseases for a longer period of time without subsequent exposures?
5)given my tests, they ABSOLUTELY trump any and all symptoms for HIV or syphilis of any type??


Thank you much for your responses and all your time and talents you devote to this forum. We all just want what is best for us and the ones we love.
Take care and God bless
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300980_tn?1194933000
Boy, your anxiety really has a grip on you doesn't it.  Fianl answers:

1) In regards to syphilis, you mentioned in "my situation".  But as a general rule, could you have syphilis past/present with repeated rpr, FTA-abs, tppa, EIA?  Meaning I guess, are there limitations to the tests that all could show negative even in presence of infection?

Our answers are individualized.  medicine is complex.  You need not worry about limitations of the tests- your situation does not warrant it.

2)you really cannot miss HIV infection with today's tests that available? Especially with the ones that I have had?

No, your tests are correct and should be beleived.

3) does it ever present a diagnostic dilemma with HIV and symptoms, when all tests are negative, or do tests always rule?  

Test always trump symptoms.

4)is there ever any advantage to testing for these two diseases for a longer period of time without subsequent exposures?

No, further testing is a waste of time and money.

5)given my tests, they ABSOLUTELY trump any and all symptoms for HIV or syphilis of any type??

Correct (again).

EWH

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Avatar_m_tn
Thank you again. I did want to clarify one thing.
1) If I had previously treated myself with doxycycline would that cure syphilis?  A few years back I took for about two weeks.
2)are the treponemal tests universally positive even after tx as the literature says? Or with tests results, I've never had?
The reason I ask is for the health of my child and if I should get him tested as I could have transmitted to my wife prior to pregnancy and given him congenital syphilis but I show all neg. I just wanted your thoughts on that. More for him  than for me.
Thank you--that is all.
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300980_tn?1194933000
Nothing more to say.  Your questions have been answered repeatedly.  EWH
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Avatar_m_tn
Dr Hook, unless I missed in translation, given my tests and results:
1)could I have ever had syphilis?(trep specific tests always stay positive?)
2)if so, should I have my son tested?

That's all I wanted to clarify. Sorry for the misconfusion. I just am looking out for him.
Thank you
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Avatar_m_tn
Dr Hook, please, unless I missed in translation, could you please answer this FINAL question?  No more---a PROMISE.
1)given my tests and results could I have ever had syphilis?(trep specific tests always stay positive?)
2)if so, should I have my son tested?

That's all I wanted to clarify. Sorry for the misconfusion. I just am looking out for him and his long term health.
Thank you
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300980_tn?1194933000
1.  Typically treponemal tests do stay positive, even after treatment.  You said you had a negative EIA.  You have not had syphilis.

2.  I see no reason for your son to be tested.  EWH
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