Collosal mistake

[smoothudd]

Dear Dr. HHH-

7 months ago while on a missionary trip to Cameroon, Africa I had unprotected vaginal intercourse with a Cameeronian woman/sex worker from the local town. Unfortunately, I was heavily intoxicated and failed to use a condom. We had intercorse three times and I believe one of them was included anal sex. I live in the US and 3 weeks after my return I developed a nasty cold with some gland swelling. I thought it was a regular cold however few days after I developed an itchy- red rash in the inner aspect of my legs that extended to my calves. It was extremely itchi and looked like an urticarial/psoriatic rash (based on pictures I see in the internet) Only affected my legs. Based on this, I immediately got tested for HIV and other STDs including, symphilis, gonorhea, herpes and acute hepatitis A, B and C. All test were negative including a HIV-1 RNA and HIV 1 & 2 Ab (EIA).

I retested with the HIV 1 & 2 Ab (EIA) at 12 weeks and more recently at 180 days after the episode- the tests remain negative. Unfortunately I have developed significant fatigue over the past few months and feel my lymph nodes are swollen underneath both sides of my jaw. I saw my PCP and he reviewed the testing above and said that he would repeat the HIV testing again in 6 months (that would be 1 year after the episode) as this could be a different HIV serotype? not sure what the doctor was thinking. I am deeply concerned that this could be HIV-2 that has not been detected becase of the lack of sufficient sensitivity of the existing tests in the US.

I am not sure if you are actively seeing HIV pts and/or if this is something you encounter often in your clinical practice, however would greatly appreciate your thoughts and professional recomendations in this situation.

Based on the above testing I have continued my normal sexual life with my spouse and I am terrified with the thought that not only I can be HIV1 or HIV2 + but that I have infected my love ones.

Many thanks

[Edward W Hook, MD]

This will need to be my final reply.  If you had secondary syphilis to account for your symptoms, your syphilis blood test would have been positive.  EWH

[smoothudd]

Thanks Dr. Hook. A last question about syphilis. I understand that secondary syphilis can lead to myalgias, joint pains and abdominal pain with generalized lymphadenopathy- all of the symptoms I am/have experienced for several months now. I did have testing for it. Syphilis IgG at 3 weeks after the encounter when I had the initial symptoms I described in the original post and at 3 months. Both results were as follow
Syphilis IgG <0.2 (Non-reactive < or = 0.8 AI).

Of note, I took 3 days worth azythomycin prior to the first test (again due to the initial soar throat, etc).

Is it possible that my curent and persistent symptoms could be syphilis related? Or can this be partially treated syphilis?

Is it worth to repeat the Syphilis IgG, or is there a more sofisticated test that one can use ?

Thank you again

[Edward W Hook, MD]

I would not worry about "other retroviruses" or EBV.  Your question makes me think you are spending too much time on the internet.  As I said before, I would not worry aobut STIs of any sort.  If you are concerned, you should discuss your concerns with a good general internist.  EWH

[smoothudd]

Thank you again Dr. Hook.

Would appreciate your thoughts about point 3 specifically other retroviruses and even perhaps EBV infections.
Thx

[Edward W Hook, MD]

While HIV-2 is more common in Cameroon than in many other regions, HIV-1 remains the major cause of AIDS.  Approved tests for HIV-1/2 have Ben rigorously evaluated and provide accurate results.  You should believe the test results you have and further testing for HIV-1 or -2 is not needed (including PCR testing).

You symptoms several weeks after your encounter could be due to any number of causes.  Your tests prove that they were not due to HIV but what they were due to may never be known.  You do not have HIV-1 or -2 from this encounter and do not need further testing.  EWH

[smoothudd]

Thank you for taking the time to answer this question. My PCP is not a HIV expert so your opinion means the world to me.

I am somewhat comfortable with the HIV-1 testing as I have both HIV-1 RNA at 4 weeks and the HIV1/2 EIA at the same time followed by a second and third test at the intervals discussed above. My biggest concern is the HIV-2. As I read, this subtype of HIV is endemic in Cameroon and is probably more lilely than HIV 1 in that region (please correct me if wrong). I tested at a major univesity hospital in the East coast but not sure if their test specifically looks for HIV-2.

1. Should I test specifically for HIV2; if so what test (RNA or EIA)?

2. How does the current HIV 1/2 EIA discriminates between the two types?

3. How can one explained thse symptoms I had 3 weeks after that episode? I look at pictures of HIV rash and the one I had is exactly what one sees on-line (it was just super itchy and only in legs)

3. If you tell me I am 100% HIV 1 and HIV 2 free, I would believe you as you are the HIV expert and I know you see pts with this disease all the time. However are there other viruses I could have acquired through this sexual act- people talk about other retroviruses. If so, is it worth testing for?

Apologize for the many questions, as you can see I am still anxious about the whole thing, mostly becase I can not explain any of the early symptoms I had. Thank you again for your generosity and willingness to provide your expert opinion in these forums.

[Edward W Hook, MD]

Welcome to our Forum.  Dr. Handsfield and I take questions interchangeably and you I happened to pick up this question.  FYI, while our verbal styles are somewhat different, we uniformly have agreed on the content of our replies for years.

I agree with you.  The exposure you describe put you at substantial risk for HIV.  Further, there is some risk for both HIV-1 and a small risk for HIV-2.  It also appears however that you were lucky and now, after multiple tests doe HIV-1 at 12 weeks and 6 months, you can be quite confident that you were not infected.  At this time I would recommend that you look for other possible causes of your symptoms.  The tests you describe would have detected infection if it were present.  Stories of so-called "rare" stereotypes are an overstatement and should not worry you.

I hope is comment is helpful to you.  EWH