opinion on blood work & symptoms

[finsterman]

Please help me determine what I might be dealing with.

October 3 - potential (?) risky sexual exposure, condom-protected (penetrative) sex, after exposed penis/vagina genital contact (non-penetrative)
November 28 - one terrible night of nausea & vomiting/ stomach flu?????
Next 45 days - always chilled, generally/non-specifically felt unwell; armpit pain/node pain?...¦
January 3 - negative HIV test (Orasure)
January 5 - started itching all over
January 30 - URQ pain; saw PCP - suspected Gall bladder issue. Blood/Urine results showed all within range/normal EXCEPT following: ALT elevated 49, GGTP elevated 124, Lipase elevated 148. (AST within range 20; amylase within range 74) Abdominal sonogram negative.
February 8 - URQ pain lessened to a degree; follow-up blood work showed all normal/within range. (ALT 43, Lipase 19, amylase 39) GGTP not tested for reason unknown. (AST was 22) PCP didnt even test for hep. Why? is it the low probability of transmission????
Today - still itchy all over, URQ pain/discomfort less intense than 1/30, but real, constant.

Are blood work results classic presentation of or indicative of Hep b/c? Ie. Would blood work levels present differently if so? and can I rule out hep b/c acute infection based on above?  

My PCP is not obviously worried given my clear blood work of 2/8...

What do you advise?

[H. Hunter Handsfield, M.D.]

You had a very low risk sexual exposure, one that had no realistic risk of HIV, hepatitis, or any other STD, and your subsequent illness probably had nothing to do with it.  From your description, it sounds possible you had acute viral hepatitis, but any number of other things could explain it; transiently abnormal liver function tests have many possible causes in addition to viral hepatitis.  In any case, with the liver tests back to normal, you have no apparent worries.  You can be sure it isn't hep C (which in rarely sexually transmitted and not considered an STD), and probably not hep B; those are relatively prolonged illnesses and the liver enzymes typically stay elevated for several weeks, even a few months. And if it was hep A, there is no chronic carrier state or other long term health problem once the enzymes return to normal.

Not being a mind reader, I cannot say why your PCP did not test for viral hepatitis.  But it seems likely that for the reasons above, s/he simply did not suspect viral hepatitis.  Perhaps there was evidence of another obvious cause of the problem.  What did s/he say when you asked?

What do I advise?  Follow up with your PCP if you remain concerned.

Good luck--  HHH, MD

[finsterman]

Thanks.

My "only" worry is that is have infected my wife (Hep B?)in the interim.  Not such an insignificant thing.  My point, albeit not that of high moral standard, is the sheer hope that I can prevent my wife from learning about and/or suffering both emotionally AND physically from my bad choice. A hard cross to bear...

As HIV and Hep C are out of the question, only Hep B remains as a possible STD and tangible indication of my extra-marital "incident."  As you stated, this is low probability, and i was seeking a medical position that would substantiate such an improbability. SO, as you say i have no apparant worry now that my liver tests are normal, please appreciate my reality in the whole context of the situation.

I thought you deserved that explanation, in hope it will help others on this Board with lives behind their questions.

All the best, and kudos to you on your great help to all.

[H. Hunter Handsfield, M.D.]

"My 'only' worry is that is have infected my wife (Hep B?)in the interim. Not such an insignificant thing. My point, albeit not that of high moral standard, is the sheer hope that I can prevent my wife from learning about and/or suffering both emotionally AND physically from my bad choice."

Of course you don't want to harm your wife.  But the relationship impact could be easily avoided.  A sizeable minority (maybe 25%, but that's only a rough guess) of hep B cases have no known route of exposure--no apparently sexual acquisition, no known blood exposure.  Many of them probably result from unknown small blood exposures.   (Before somebody jumps in with the "why not HIV? question:  HBV is 1000 or more times more easily transmitted than HIV.)  So occurrence of hepatitis B doesn't carry the same implications for sexual fidelity than other STDs.

[finsterman]

Thanks for your comments.  It's certainly a point to consider...

That said, and all things considered with my situation, and from the position of both doctor AND man, should i:

1)move on with my life, as my liver tests are normal and/or not indicative of hep b, my exposure was such a low risk, etc?

or

2)get tested for hepb anyway and roll the dice, potentially leading to a potentially delicate conversation that may have not been needed in the first place?

tricky one, heh?

[monkeyflower]

Since you're worried enough to post, why not just get tested? It's not tricky at all--the only "delicate conversation" would have to be if it does turn out that you have hepatitis b. And if you don't, well, then you can move on... nothing needs to be said :-)