Coinfection?

[VeryWorried1212]

Dear Doctor H,

I have searched the forums and threads and am still confused on this topic.  

I had unprotected exposure with a female stripper.  Since then have had many signs or symptoms; white tongue, sore muscles, fever (three days), night sweats and dark smelly urine (for about ten days which is now gone).

I had a negative rapid test at 83 days.  However, I am now reading that coinfection with Hep B or C could have happened or could be the reason for my "symptoms".

Now I am worried that the 83 day test is not conclusive because of coinfection or delayed seroconversion.

Will get a Hep test done this week but now freeking out over Hep as well.  Please advise or comment.  Thank you very much.

[H. Hunter Handsfield, M.D.]

I don't know what you read (or what you might have misinterpreted), but those symptoms are not particularly suggestive of HBV or HCV.  HCV isn't sexually transmitted (despite what you can find on the web), so that's not even a theoretical concern.  In any case, the likelihood of HBV transmmission was very low and I would not have recommended testing at all, except to relieve your anxiety.  You can be certain the will be negative - or if positive, that you got it somewhere else, not from your adventures with the stripper.

Having hepatitis (or any other infection) does not alter the results of HIV tests.  Your 83 day HIV test was completely reliable; you don't have HIV.

Good luck--  HHH, MD

[VeryWorried1212]

Doctor,

Good morning and thank you for the quick response.  I am very glad to hear that you believe the HIV test is conclusive.....thank you.

My only follow up would be why you believe that HBV transmission would be considered low...... just trying to understand your reasons.  

Unfortunatley, everything I have read says it's very contagious through any form of unprotected sex and the first signs are dark urine and muscle soreness.......that of course though is why I am seeking your thoughts.

Thanks again!

[H. Hunter Handsfield, M.D.]

"Very contagious" is a relative term.  The chance that any particular sex worker is carrying transmissible HBV is under 1%.  If your partner was a carrier, the chance of transmission during any particular sexual event is around 1 chance in several hundred.  If you assume the latter risk is 1 chance in 200, then the likelihood you were infected is 0.01 x 0.005 = 0.00005, or 1 chance in 20,000.  Your lifetime risk of being struck by lightning (if you live in the US) is said to be 1 in 27,000, i.e. about the same as the likelihood you caught HBV.

So I cannot say you weren't infected. And yes, your symptoms could have been due to hepatitis, but there was no particular reason to suspect that over many other possibilities.  You don't describe abdominal pain (which comes from liver inflammation), which usually is present in people with sufficiently severe hepatitis to cause the other symptoms you describe.  And anything that causes fever typically results in mild dehydration, which concentrates the urine, with darker color and increased odor as a result.

Anyway, those numbers are why we rarely test for HBV in heterosexual STD clinic patients, unless they are injection drug users.  However, all people ought to be vaccinated against HBV.  So if you want to be tested, it's fine with me.  But if the result is negative (or if you just decide to skip the testing), this is a good time to get immunized, since the issue is on your mind.