What can be causing this

Dear Dr.,

15 months ago, I had an encounter with an African prostitute in a bar in Belgium. I performed oral sex on her, but did not know she was on her period. Two days later, I developed glossitis on the lateral border of my tongue, my stomage hurt over weeks, nightsweats after 3 weeks. As I went back because of my symptoms, she told me she was not tested for years. The last time was 3 years ago, as she received a baby. She came to Belgium at age 17, and now she is 24.

I felt fatigue over months(10 months). The fatigue was gone after taking aciclovir. I also developed a sore throat until now. After six months, I developed arthritis pain in my legs and eye pain.

One week after the encounter, I had slightly elevated leuco's, and my lympho's were low(14%, ref 21-41%). This happened at least 4x the last year. After a few weeks after encounter , my liver enzymes started to raise, AST 15 -> 32, ALT 17->33, over a timespan of at least 3 months. They are normal now. My STD's came back negative, except for CMV. I was also tested for Herpes 8 and mycoplasma's. All neg. Although I doubt the myco's test, because 2 weeks before the test, I ended a 3 weeks course of doxycycline.

Now I'm diagnosed with some systemic disease.

My question(s) now is(are):

- what agent can cause a raise of the liver enzymes over months(at least 3 months). A hepatitis strain I was not tested for ?

- Can I be infected with a retro-virus, and develop after years, AIDS ? There are medical reports of cases of people who get AIDS, being HIV-.

- Can EBV contracted via oral sex, because that's also an option. My doc tested me in 2003 and I tested neg. Now I'm positive, so he thinks I contracted EBV.

- Can I be infected with a HIV-strain I was not tested for ?
- Can I move on with my wife and fullfilling our child wish or is the risk too high to pass (other) infections to her ?

Overstressed.

[Edward W Hook, MD]

Your problems and questions are quite broad and while I can give some preliminary advice, what you really need to do to get them addressed is to work through your concerns with a trained health care provider, i.e. and internist or infectious diseases specialist.  In addition, by way of back ground, you stated you were tested for STDs.  I presume this includes HIV.  If so, your HIV-related concerns are misplaced and are not something you need to worry about.  Now, on to your questions:

1.  You do not say what hepatitis variants you were tested for.  Whatever happened has apparently now improved, at least in terms of hepatitis.  In addition to the hepatitis viruses both CMV and EBV can cause a hepatitis. Both are also VERY common and as such might be part of what went on for you.  A word of warning however. Because these infections are so very common, if you are tested and have them, that does not in any way mean that they caused your difficulties.
2.  If you were tested for HIV, then that is not your problem.  Other retroviruses are unlikely and, as I mentioned above, pursuit of this very unlikely possibility is best carried out in consultation with a physician, not over the internet.
3.  Yes, EBV can be contracted through oral sex. Unlikely but it happens.  As I said above, if you test positive for EBV, this does not mean that is the reason for your continuing symptoms.
4.  No, the HIV tests would have picked up HIV, even HIV-2.
5.  There is no evidence that  you have an STD, including HIV.  I see no reason from that perspective not to pursue a family.  

EWH

[overstressed]

Dear Dr.,

let me add some info to my posting:

- I was tested regularly(the last year) on HIV 1/2, the last time after 10 months, which came back negative.
- I was regularly tested(the last year) on Hepatitis ABC, all came back negative. Never ever had an infection before, obviously. Last time(a month ago, thus, after 14 months), my housedoc performed again a hepatitis C -test, that came back neg too.
- I was also tested on HTLV 1/2, that was negative too. This test was only one time performed, the last year, but the biologist from the LAB told me that the ELISA-test was 100% sensitive and specific.

All test were anti-body tests, no PCR was performed, except for Herpes 8, Mycoplasma and Herpes Simplex 2(performed by RedLabs(www.redlabs.com)

After 10 months and after continuation of the pains, I went to an University Clinic here, and consulted the(!) infection specialist-internist from Belgium, who diagnosed me with the systemic disease. Before that, I was under consultation of an infection specialist-internist of a Tropical Clinic-STD center, in Antwerp. His advice was to continue having my tongue checked and seek psychological help, which I did.

The professor from the University hospital told me that I was not, and I'm not infectious to anybody. He put this also on paper, and had this report sent to my housedoc. According to him, I do not have to come back for follow-up. He just prescribed me the immune suppressive meds for 3 months.

But I'll be going back, since it does not help me much. Most of my complains are my r-eye. I have to wear glasses now, since my far-sight has decreased a lot.

Thank you for your advice Dr.,

kind regards,
Overstressed.

[Edward W Hook, MD]

Thanks for the clarification.  It sounds to me as though you are working through this with a capable, knowledgable specialist.  No real change to my recommendations.  Good luck.

EWH

[overstressed]

I also forgot to mention, as I did not have any sex with my wife, over the past year, at the time of my incident, she started to develop lupus-like lesions on her back. We both lost 10% of our weigth, which we gained back, now. I must have infected her with saliva, and because of this, my housedoc strongly suspects EBV.

But my wife refuses to see a dr for these lesions, mainly because she does not know what happened. She feels ok, she says, but she's not, if I compare the way she was before.

Thanks,
Overstressed.

[Edward W Hook, MD]

Still no change in my advice other than to say that your wife should see someone, even if it just to satisfy your concerns.  It would be best if she saw the same specialist that you are seeing.  EWH

[overstressed]

Thanks a million, Dr!

With kind regards,
Overstressed.