Possible DGI

[bdonovan]

Dr's -

My primary concerns/symptoms when I was first questioning HIV risks are still here despite visiting numerous doctors and countless labs.  A brief history:  I had an unprotected oral encounter both receptive and insertive with a man of unknown status on July 3rd 2009.  Roughly 10 days later I had acute pain in my testicle.  I visited my PCP and she ordered an ultrasound (negative) and referred me to a urologist.  He preliminarily diagnosed me with epididymitis .  My PCP had already prescribed me 7 days of 1000mg of cipro and 10 days of 200 mg of Doxy.  The symptoms gradually changed to a heated skin feeling abdominal pain and migratory arthralgias and general feeling of being not well.  No fever, no discharge and a negative urine test done 3 weeks ago.

Here we are a full 8-9 months later and the joint pain has progressed and is now in all major joints and along with wrists ankles and some foot and fingertip pain.  Where as it used to be 2 week flare ups, it's now ongoing.  The testicle pain still persist but not as bad as the onset.

I have seen 3 rheumatologists and had countless amounts of labs done that have come up negative for any type of arthritis.  One Dr, Dr. John Atkinson - head of rheumatology at BJC Wash U is stumped.  

My question(s) is, could this be DGI or complications from asymptomatic gonorrhea?
Would the Cipro and Doxx have cured it 100%?
Would the countless labs done over the last 9 months have tested positive for arthritis or shown inflammation if I had reactive arthritis or DGI?
Would the urine test (culture) be positive if I had DGI?
What test should I ask for if the proper ones have not been done?
Could this be another STD (negative for HIV out to 7 months, and Syphilis out to 4 months)?

The pain is real.  I am a very active guy and I am experiencing diminishing returns as of late.  I am not a hypochondriac nor am I neurotic, but this is seriously effecting my quality of life.  

Thank you in advance for any insight or answers -

[H. Hunter Handsfield, M.D.]

We don't ask much of questioners, but we do expect them to read and pay attention to our answers.  I have already said there are no STDs "...that would cause symptoms like you describe", "...your joint pain has nothing at all to do with any STD or with the sexual encounter you describe last July", and "You and your doctors need to be looking to something other than the sexual encounter last year as the origin of your symptoms."  

You do not not have gonorrhea and should not have any furhter STD testing of any kind.

This thread is over.

[bdonovan]

Last question -

Would you advise in further testing?  Blood tests, etc?  The only test I had for gonorrhea was a negative urine culure 3 weeks ago (8 months after the encounter).  I know the internet is the wrong place to search on your own for answers - but all the symptoms I have point towards a continued infection, specifically the pain in my feet and joints along with lower back pain and abdominal pain.

What tests should I ask for, or do you feel that after 8 months and Cipro and DOXX that this should be put to bed?  My concern is that there are supposed drug resistance strains of gonorrhea.

Thanks again -

[H. Hunter Handsfield, M.D.]

Gonorrhea usally clears up on its own within a couple of months, and it's even less likely you could still be infected after those antibiotics.  It is extraordinarily unlikely your test will be positive.  The neg won't tell whether or not you were infected in the past, but in any case gonorrhea is irrelevant to your current symptoms.  You and your doctors need to be looking to something other than the sexual encounter last year as the origin of your symptoms.

[bdonovan]

Thanks for the prompt reply.

As for your opinion of how reliable my urine test is from 3 weeks ago?  Would I test positive without exception if I still had gonorrhea (8 months later)?  Would the Cipro and Doxx at such high dosages have cured gonorrhea if I had it or should I seek further testing?

Thanks again -

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

DGI is an acute arthritis requiring antibiotic therapy.  Even without treatment, it goes away within 3-4 weeks.  It may severely damage or even cripple the involved joints if not treated with antibiotics -- but in any case it does not last 3-4 months or longer. Further, any rheumatgologist would know this and wouldn't miss the diagnosis.

As for reactive arthritis (formerly called Reiter's syndrome), you should ask your rheumatologist(s) whether they have considered it, since it can be triggered by STDs including gonorrhea or chlamydia, as well as by various non-STD intestinal infections.  It would be surprising if they have not thought about it and ruled it out, because RA is an everyday, "bread and butter" condition for all rheumatologists.

As for other STDs, there are none that would cause symptoms like you describe.

So my guess is that your joint pain has nothing at all to do with any STD or with the sexual encounter you describe last July.  But this is definitely not something that will ever be sorted out by online searching or any forum, this or any other.  The answer, if and when it comes, will be from direct evaluation by a knowledgeable medical professional.

Sorry I can't be more helpful.  Best wishes--  HHH, MD

[bdonovan]

**Edit - Please delete my rheumatologist name, hindsight I should not have listed it** thanks