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Symptoms and Tests
Dear Dr. thank you ahead of time for answering my questions. I had unprotected sex (vaginal sex) with a woman of unknown status 17 weeks ago. Two weeks after the encounter I came down with symptoms that I have never felt before in my life. They were extreme muscle spasms in calves and hamstrings, rectal discharge, lymph node swellage all over body and widespread muscle pains and a feeling of being hit in the back of head with a baseball bat! It feels like something is almost attacking my nervous system by the involuntary muscle twitching I am experiencing and the back of my neck is in pain leading into the back of my head. These symtpoms have been dragging on for 4 months. I had a metabolic panic done 11 weeks after encounter which was normal. had cbc done which was also normal, got tested for hep a,b,c neg, ebv, hsv, hiv, and all came back neg. I had another hsv and HIV test done at 14 weeks which was elisa and came back neg. The only reason I am on here is because I went to planned parenthood last week and had a 17 week or 4 month rapid test done and was neg but they took a urine sample and said there was an infection present in my urine but could not tell me what it was. I have taken 2 rounds of doxycycline prescribed by a dr. and there is still an infection present 4 months after this encounter. I have a couple questions which are: 1.) Is a 17 week unigold rapid finger prick 100% reliable and conclusive? 2.) Would my rapid test have been positive if in fact the infection present was HIV? 3.) Would my blood work have shown any irregularities if HIV was the case? 4.) Do you recommend any further testing? I am just nervous because the infection has lasted so long and the anti-biotics have not helped and have not got a definitive answer as to what it is. Trying to keep a level head but the duration of this is what bothers me doc
MEDICAL PROFESSIONAL
I apologize that I missed your original mention of doxycycline. Having had 2 courses of it, no STD is a possible explanation of any ongoing symptoms or abnormal lab tests. Whether or not you started with an STD component to explain the earliest abnormality in your urine, I cannot say.
However, another possibility comes to mind, which may or may not be related to your sexual encounter or to STD. Has reactive arthritis (formerly called Reiter's syndrome) come up for discussion? Can you aches and pains can be attributed to arthritis, especially arthritis involving the spine? Reactive arthritis can be triggered by NGU, chlamydia, and various non-STD intestinal or rectal infections, and it also can be accompanied by non-infectious urethritis. In theory, RA could tie in your rectal discharge, WBCs in the urine (if that's the lab finding that raised Planned Parenthood's concern), and perhaps other symptoms. A related possibility is inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, which can behave a lot like reactive arthritis and could explain the rectal problem. (No STD is a possible explanation for that symptom, assuming you have not received anal sex by another man.)
If these possibilities seem realistic, referral to a rheumatologist (arthritis specialist) would be a logical step. (From all you have said, I continue to be puzzled about the need for endocrinology evaluation.) Anyway, at this point any and all STDs that could explain your symptoms or any abnormal lab tests have been effectively treated. These are ideas for you to raise with your doctors, not ones I can explore further on this forum, since active STDs and HIV are clearly out of the picture. I'll be interested to know if the reactive arthritis possibility pans out, but otherwise that will be all for this thread; I won't have any further comments or advice.
However, another possibility comes to mind, which may or may not be related to your sexual encounter or to STD. Has reactive arthritis (formerly called Reiter's syndrome) come up for discussion? Can you aches and pains can be attributed to arthritis, especially arthritis involving the spine? Reactive arthritis can be triggered by NGU, chlamydia, and various non-STD intestinal or rectal infections, and it also can be accompanied by non-infectious urethritis. In theory, RA could tie in your rectal discharge, WBCs in the urine (if that's the lab finding that raised Planned Parenthood's concern), and perhaps other symptoms. A related possibility is inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, which can behave a lot like reactive arthritis and could explain the rectal problem. (No STD is a possible explanation for that symptom, assuming you have not received anal sex by another man.)
If these possibilities seem realistic, referral to a rheumatologist (arthritis specialist) would be a logical step. (From all you have said, I continue to be puzzled about the need for endocrinology evaluation.) Anyway, at this point any and all STDs that could explain your symptoms or any abnormal lab tests have been effectively treated. These are ideas for you to raise with your doctors, not ones I can explore further on this forum, since active STDs and HIV are clearly out of the picture. I'll be interested to know if the reactive arthritis possibility pans out, but otherwise that will be all for this thread; I won't have any further comments or advice.
I actually have an appointment with the university clinic on Thursday for about the 7th time this semester and really do not know what to tell them to run tests for at this point. Do you have any suggestions doc?
After my visit I was curious to if they knew what it was so I called planned parenthood and they could not tell me what the infection was, they just said that there was an infection present in my urine. Other than that they did not hint of any specific infection or give me any other info. I went to a Dr. as well and he was no help really he just looked at my lab results and gave me doxycycline and sent me on my way. I have now taken two rounds of doxycycline and planned parenthood actually gave me some more but it has not helped up to this point. It's just that the infection has lasted for so long doc thats what worries me. It seems my symptoms get worse after alcohol as well but not sure if that matters. I actually have the letter in front of me where they referred me to an endocrinologist stating that paying cash would be $245 for a one time visit.
MEDICAL PROFESSIONAL
Actually, a coincidence now seems a good bet to me too. You don't say exactly what evidence of "infection" was found in your urine or if it is consistently present. Most likely, increased white blood cells have been seen. If so, you should be evaluated for NGU as I described above (close examination after no urination for 6+ hours) and tested for non-STD urinary tract infections.
In any case, referral to an endocrinologist doesn't make sense to me. That's not a specialty that would typically evaluate for unexplained infections. You're sure you don't mean an infectious diseases specialist? Or maybe the urine abnormality isn't actually sign of an infection? If not, then for sure it has nothing to do with the sexual encounter.
Nonchlamydial NGU is generally harmless and probably clears up on its own. But at this point, NGU seems unlikely to me.
In any case, referral to an endocrinologist doesn't make sense to me. That's not a specialty that would typically evaluate for unexplained infections. You're sure you don't mean an infectious diseases specialist? Or maybe the urine abnormality isn't actually sign of an infection? If not, then for sure it has nothing to do with the sexual encounter.
Nonchlamydial NGU is generally harmless and probably clears up on its own. But at this point, NGU seems unlikely to me.
I actually have already tested negative for chlamydia and ghonnorea since the encounter a few times due to the fact that the symptoms have been persistent. I live here in Texas and am going back to my university clinic on thursday but I have been there 6 times this semester and they keep wanting to refer me somewhere else thinking it has nothing to do with an std because of my numerous negative results and think its just a coincidence but I know that's not the case. They actually referred me to an endocrinologist but I do not have health insurace so did not go. Does NGU go away on its own or would the doxycycline not have gotten rid of it?
MEDICAL PROFESSIONAL
Welcome to the HIV forum.
I have 3 take-home messages for you. First, assuming you are in the US, where heterosexual HIV transmission and HIV infection in women both remain very rare in most populations, your exposure is considered very low risk for HIV. Second, your symptoms don't suggest HIV, and even when symptoms are typical for HIV, usually other things are the cause -- because so many minor conditions are much more common than acute HIV infection and cause the idential symtpoms. Third, HIV test results always trump symptoms and exposure history, as long as testing is done long enough (more than 6-8 weeks) after the last possible exposure. Thus, your negative test results prove a) that you were not infected and c) something other than HIV explains your symptoms.
So for sure you don't have HIV. However, it sounds like a good bet that you caught chlamydia, or nongonococcal urethritis (NGU), since those are the most likely causes of signs of infection on urinalysis. I'll come back to this below, after answering your numbered questions.
1,2) 100% conclusive and yes your rapid test would have been positive if you were infected. For sure you don't have HIV.
3) Routine blood work, like a CBC, says nothing one way or the other about HIV.
4) You do not need any further HIV testing.
Coming back to your abnormal urine: As I said above, NGU or chlamydia is a good bet. Gonorrhea is also possible, but unlikely. My guess is that the Planned Parenthood clinic sent your urine for gonorrhea and chlamydia testing. If not, you definitely need those tests. In addition, you should be examined closely by an STD-knowledgeable provider, preferably at a time you have not urinated for several hours, to see if there is any abnormal discharge from the penis. (You can also examine yourself closely for the same thing.)
Please feel free to return with a follow-up comment after you have been re-examined and/or your gonorrhea/chlamydia test results are available. In the meantime, put HIV out of your mind. You don't have it.
Regards-- HHH, MD
I have 3 take-home messages for you. First, assuming you are in the US, where heterosexual HIV transmission and HIV infection in women both remain very rare in most populations, your exposure is considered very low risk for HIV. Second, your symptoms don't suggest HIV, and even when symptoms are typical for HIV, usually other things are the cause -- because so many minor conditions are much more common than acute HIV infection and cause the idential symtpoms. Third, HIV test results always trump symptoms and exposure history, as long as testing is done long enough (more than 6-8 weeks) after the last possible exposure. Thus, your negative test results prove a) that you were not infected and c) something other than HIV explains your symptoms.
So for sure you don't have HIV. However, it sounds like a good bet that you caught chlamydia, or nongonococcal urethritis (NGU), since those are the most likely causes of signs of infection on urinalysis. I'll come back to this below, after answering your numbered questions.
1,2) 100% conclusive and yes your rapid test would have been positive if you were infected. For sure you don't have HIV.
3) Routine blood work, like a CBC, says nothing one way or the other about HIV.
4) You do not need any further HIV testing.
Coming back to your abnormal urine: As I said above, NGU or chlamydia is a good bet. Gonorrhea is also possible, but unlikely. My guess is that the Planned Parenthood clinic sent your urine for gonorrhea and chlamydia testing. If not, you definitely need those tests. In addition, you should be examined closely by an STD-knowledgeable provider, preferably at a time you have not urinated for several hours, to see if there is any abnormal discharge from the penis. (You can also examine yourself closely for the same thing.)
Please feel free to return with a follow-up comment after you have been re-examined and/or your gonorrhea/chlamydia test results are available. In the meantime, put HIV out of your mind. You don't have it.
Regards-- HHH, MD
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