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Suspecting Infections
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Suspecting Infections

Yes, the story begins with an exposure of receiving unprotected oral and frottage with condom from an unknown status girl 3 months ago.

And lets skip to 3 months later, I have been checked for hiv (12 weeks), herpes, hepatitis B, C, chlam and syphilis. ALL NEGATIVE. However, experiencing muscle aches (particularly significant on upper back, neck and buttock area), involuntary muscle twitching, weakness in legs, on and off single itchy rash, easy bruising and sudden numbness on my back.

I complaint to several GPs and they said its due to anxiety but the symptoms were sometimes very significant which they affect my daily life. According to my symptoms above, I think it resembles sort of chronic viral infection as it persisted for more than 2 months. Even if it was acute hiv infection, it wouldnt last that long and my 12 weeks hiv test is conclusive so I would just exclude it.

Apart from std test, I also did complete blood count, everything was normal except the monocyte level was quite high @ 9 (range: 2-10). This was the only concern as I did 2 blood counts as well in the past 2 months, all having elevated monocyte count. can anyone suggest any infection that I might got, according to my symptoms and monocytosis symptom? One more, the report showed that my Erythrocyte Sedimentation Rate (ESR) was beyond the border line which is 16 mm/hour (range: 2-10). And these 2 factors were known due to chronic inflammation or infection. Please help if u have any idea on my situation.
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Avatar_f_tn
Hi and sorry you are having these problems. I am not a doctor I am a microbiologist so I can only advise you on these things.

You don't have a sore throat or swollen lymph nodes under the neck and/or arm pits? No high fever? If so I would say get a test for Mono. But if you don't there is no point in doing it. Most people are positive by adult hood. So if you didn't have these symptoms and didn't get a blood test to look for Early antigen IgM and viral Capid antigen IgM it would be too late now.

Where is your rash? Yes a chronic viral infection is possible but not sure why it would cause the numbness in the back. How long have you had this? Again you don't have a fever? Can you touch you chin to your neck?

The monocytes aren't high if they were 9 and they were in range. It would have to be above range to be high. It doesn't matter if it is on the high end of the range. The ESR is non specific and generally looks for inflammation.

So did you injure your back perhaps when you had sex? It is possible. You may want to get an MRI or Xray to see if there is anything wrong with the back and/ or pinching a nerve. If these tests are normal you could see a neurologist.

mkh9
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Avatar_m_tn
Hello and thanks for your prompt  response. I have stiff and achy necks occasionally but there is no swollen nodes on neck according to several inspections from different GP. And for the fever part, I'm experiencing chills but the temperature is normal obtained from ears. As for mono, I'm not sure whether I got it before or not, just a blur recall that I had once very swollen lymph nodes at neck but healed with traditional Chinese remedies. And when I requested for test, the GPs said that mono is harmless and no point wasting money on testing it, it's all cause of anxiety.

However the abnormal body responses such as blood count and physical symptoms made me worried. Yeah, for the aches they are significant on upper back, region near the rib cage and buttock. They weren't persistent but able to feel when I touched these areas. I just got my health screening result yesterday and the GP said my liver was functioning good and I'm immunized to hep A and B.

For the std part, I have done whole std panel on week 12, hep c and hiv were negative. We're these results valid and reliable? Was worried about the cpinfextion of hiv and hcv which prolonged the window period of hiv beyond 3 months. For my sexual exposure, the only contact I think of is saliva as I only did French kiss and receiving oral from the girl, no penetration involved. Transmission of hiv and hcv thru saliva is quite unlikely isn't it?

Hope to get back from you, worried
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Avatar_m_tn
Forget to mention, my monocyte count on my health report last year was only 2 that's why I'm worried with the persistent 9 value for months. For the rash part, it appears like mosquito bite which is itchy and every time they come in 1 or 2 puffs only that come and go in few days. GP said it was due to air pollution. But I dont think so
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Avatar_f_tn
No you shouldn't have to worry about hepatitis C or HIV from saliva. You don't transmit Hep C  from kissing. It has to be from blood. HIV you don't get from saliva. It extremely low risk to get HIV from receive oral sex  for a man. There also has to be blood in the mouth such as open wound or sores. So your 12 week HIV test was a 4th generation HIV test? If so you have nothing to worry about if negative. Most other tests at 3 months are pretty conclusive these days too. What exact test did you have for the HIV. I still wouldn't worry about it. You have little to no risk and you tested negative.

The monocytes are still normal even if they were up they are still in range. It is ok.

The rash could be due to an allergy or anything. It doesn't have to be due to an infectious disease.

Your back issues sound neurological. You may want to see a neurologist or a orthopedic back doctor. It could also have some type of autoimmune going on.

Because of where you live and the symptoms of weakness in legs and so forth why don't you get tested for parasites just in case? Get a couple of stool samples tested for fecal parasites and if you can blood parasites. But you would have a fever if you had blood parasites. I think they may have seen them on the blood smear. Not always if they weren't looking for them. Otherswise it may not be infectious.
mkh9

mkh9

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Avatar_m_tn
Yes, the hiv test i did was forth generation's ones which detects both ab and ag. Just got some confusion as the UK guidelines stated 12 weeks is conclusive but US CDC stated 13 weeks instead. In your opinion which is more reliable? Does one week makes difference?

To be more specific the weakness in legs and body aches started from 3-4 days after exposure until now. more than 3 months, i personally dont think hiv acute infection would have persist for so long and i did duo test at 19 days, 30 days, 40 days, 63 days and 84 days all tested non reactive. The probability of turning positive later is relatively low ? Would u agree with my statement?

So u suggested parasite infection ? oh yeah on that day of exposure, when i walked on the staircase, i accidentally stepped on a tiny black object but cant be seen clearly as I left my glasses in room, it hurts at first then the itch persist for almost 1 and a half week. I'm not sure whether it is the route of microbes infection or not. And another event on that day as well, after the sexual activity I just sleep with bottom naked covered with blankets. Would it be a risk as most hotels dont wash their blankets regularly and the microbes enter thru my urethra?

For hepatitis, since hep c test at 3 months is neg and the liver function test did on the same time also has normal range for every criteria as well. Should I neglect the possibility of infected with it?

Sorry for the troubling you, I am very stressed this 3 months as I am a biotechnology graduate which has scientific knowledge towards microbe and diseases and I became a slave of internet resources that match every symptoms of std with mine.

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Avatar_f_tn
Hi, and I understand your worries.  But you don't have to worry about HIV or HCV. There is no window period for the 4th generation HIV combi test but they still say 17 days after infection is the testing time, so you are way beyond that. This is the very latest update I just got from my continuing education from The American Society of Clinical Pathology.

As for the Hepatitis C it is up to 10 weeks for acute infection. So if you haven't seem IgM positive in that time then you haven't been exposed from this incident. It has been 12 weeks for you.

No I don't think you got any exposure from the sexual incident. So I am now going outside the box and leaving that behind. The parasite test would be just in case you got exposed from the environment for example eating contaminated food or undercooked pork or walking barefoot or walking in fresh water or bathing in fresh water outside the house. Some parasites can cause some of the symptoms you have. But, you could just have as I mentioned a back injury or something else such as autoimmune problem or neurological issue. So at this point I don't know what is going on. I am going by your symptoms and my knowledge. If the parasite test is negative you can repeat in a week (stool sample) if still negative you could ask for a blood parasite test. But other than that I really don't know. It is a shot in the dark but worth a try. Generally if you have a lot of parasites your Eosinophils would have gone up on your complete blood count but not always. Since you have back pain and inflammation the weakness and pain in the back and other symptoms  it fits more of a back problem that occurred or neurological. Like I said I would see an orthopedic back specialist or a neurologist at this point after the parasite test.

mkh9
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Avatar_m_tn
I really do appreciate your guidance a lot. Perhaps HIV is considered one of the most fatal disease which will ruin my future as I have to be medicated for the rest of my life and the social stigma towards hiv positive individuals. For testing for hiv, once an individual is infected, viral replication will initiate rapidly hence producing acute symptoms as the body defence mechanism respond over it. As in the replication, p24 antigen is one of the by product produced and the presence of it resembles infection. As in my case, I have been tested at a few time frame especially day 19, day 30 and day 40 which p24 SHOULD be detectable if I am infected. And from period after 6 weeks, antigen level will start to deplete and by right antibodies should start to appear as they eliminate those p24 which result in depletion of antigen. By 12 weeks, most healthy people should have produced antibodies, lets say if the person is immunocompromised, no Abs were produced hence p24 should be detectable by combi test.

Are my statements above correct ? I'm using it to persuade myself that I'm clear of HIV. By the way, according to your society's guideline, the recommended window period is 13 weeks (90 days) ? As what i recall the rest of the countries used 12 weeks protocol instead. In your opinion, does it makes difference in terms of accuracy?

Yes, according to my complete blood count, white cells are normal, eosinophil level is 0. Just my monocyte level posed some worries to me. Since your expertise is in microbiology, I'm sure u have better knowledge than me in pathogens. Would u suggest any viral / bacterial infection which cause indication on elevated monocytes ? Monocytes are also known as killers which phagocytes. Elevated amount = presence of pathogens. Am i right?

Millions of appreciation for your reply.
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Avatar_f_tn
I think you are clear of both HIV and HCV. No I do not think you have increased monocytes. I wouldn't worry about that at this time. Also your white count was normal and the neutrophils or polymorphonuclear leukocytes  or PMN's were normal so there was no sign of infection (phagocytosis). The monocytes can be raises with mono but you have no indication of this. Usually viruses like HIV for example would make the lymphocytes go down because they attack the CD4 cells (what used to be called the T helper cells), but mono makes atypical lymphocytes go up. Not monocytes even though the name is "mononucleosis".

mkh9
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