HIV/STD

[SBINDIA]

I am 31 years woman from INDIA

On 9th Feb I had an unprotected sex with a man I know for long.

On 10th Feb he called me and said he had been diagnosed Gonorrhea. And he said his last exposer was on 31st Jan from his unprotected sex (I doubt with CSW but he is not telling me).  

Then we made plans to deals with and do following.

14th Feb: He tested for VDRL and “Detection of HIV P24 antigen and antibody to HIV type 1/type 2 , architect abott, Chemiluminescent Microparticle Immunoassay (CMIA), which is most common test in INDIA. Result : Non reactive for both. And he takes meds to treat gonorrhea and cured completely.

6th March: He tested “Detection of HIV P24 antigen and antibody to HIV type 1/type 2 , architect abott, Chemiluminescent Microparticle Immunoassay (CMIA), which is most common test in INDIA. Result : Non reactive.

10th March: I tested for VDRL and “Detection of HIV P24 antigen and antibody to HIV type 1/type 2 , architect abott, Chemiluminescent Microparticle Immunoassay (CMIA), which is most common test in INDIA. Result : Non reactive for both.

Between 1st April to 7th April I found the following:

1. Lower abdominal pain with little virginal whitish discharge for 2 days and disappear.
2. Mild fever, Pain, headache, tiredness,
3. Dry skin and itching dots in my face especially around lips.(not other parts of the body)
4. Peeling skin of palm around finger and around finger of feet and at right elbow.

In a week most of the issue resolved automatically, except bit tiredness.  

I am very scared thinking that it could be HIV and unable to discuss with somebody.

What could be the cause of this symptom.

Please advise your overall view.

[H. Hunter Handsfield, M.D.]

These also are not symptoms of STD or HIV.

[H. Hunter Handsfield, M.D.]

No need to be sorry or apologize -- I'm not upset.  It's just time to move on.

[SBINDIA]

Thank you so much doctor.

Yes I agree that the discussion in this thread becomes too lengthy and  in details.

I am very sorry for that.

But thanks again for your help.  

[H. Hunter Handsfield, M.D.]

I'm glad to hear you finally were tested and have been treated for gonorrhea.  To the specific questions:

1) If you and your partner had sex after he was treated but before you were, then he needs to be treated again (with both cefixime and azithromycin).before you have sex again.

2) I see no need for repeat HIV test or VDRL.  You and your partner both should be retested for gonorrhea and chlamydia a few weeks after you both have been treated.  The chance of treatment failure is low, but better safe than sorry.

3) You can move forward without concern.

This thread is much more detailed than normally permitted on this forum.  That will have to end this discussion.  If anything remains unclear or if new issues arise, you will need to start a new thread either on this or the STD forum.

[SBINDIA]

Dear Doctor

Brief update:

I am a 31 year woman from INDIA

Urine Test indicates >>>Gonorrhea infection for me>>>Treated with by gynecologist

: Tab cefixime 400 mg orally, plus Tab Azithromnycin 1 gram.

And find abstinence of occasional virginal discharge last few days.

My partner’s Urine Test: His test is negative for both Gonorrhea and Chlamydia.

Detail update: For your convenience

My partner:  A 33 year Man from INDIA.

January 31: Have an unprotected sex with an CSW

Feb 9: Unprotected sex with me

Feb 10: Discharge started from his pennies>>>>Took gram stain test >>>indicate Gonorrhea infection>>> treated with >>>>Azithromycin (500 mg) and Amoxicillin (500mg) | Clavulanic Acid (125mg)>>> by the doctor and completely cured.

Feb 14 and March 6: My partner, He tested for twice: Detection of HIV P24 antigen and antibody to HIV type 1 and/or type 2, architect abott, Chemiluminescent Microparticle Immunoassay (CMIA)

Both the test: Non Reactive.

March 10: I tested same HIV test above and result: Non Reactive.


1.Do you think my partner need to take medicine for Gonorrhea and/or Chlamydia? (as you earlier mentioned that my partners medicine for gonorrhea treatment was not at par)

2.Do you think we both need  retest of any of the following:

a. HIV type 1 and/or type 2
b. VDRL
c. Urine test for Gonorrhea and Chlamydia

3.Can we move forward in our life without concern?

Thanks a lot for your kind advice and support for us.

[H. Hunter Handsfield, M.D.]

Thanks for clarifying.  It sounds like you may have been the source of your partner's gonorrhea -- you may have been infected before him.  Even if not, you were exposed when he was highly contagious.  Either way, you should have been treated immediately.  I have to assume his doctor isn't really very knowledgeable about STDs -- otherwise s/he would have recommended you be tested and treated.

Your partner was treated pretty well for gonorrhea, but not with the best or most recommended treatments.  Amoxicillin/clavulanic acid often would work, but not reliably; and the proper dose of azithromycin to cover chlamydia is double what he was given (1 gram, not 500 mg).  This seems to be more evidence against his or her STD knowledge.

Also, your partner's gram stain test does not detect chlamydia, only gonorrhea.  Chlamydia diagnosis requires a urethral swab specimen or urine testing.

For all those reasons, now I think there is a very good chance your previous vaginal discharge and low abdominal pain were due to gonorrhea and/or chlamydia.  Even though your symptoms have improved, the infection(s) might be continuing.  It is urgent that you be tested and treated ASAP.  I encourage you to identify a (different) doctor who understands STDs, either an STD clinic per se (if available) or a gynecologist.  And if you plan to continue a sexual relationship with this partner, he also needs to be tested and treated with proper drugs.  He also could still be infected, without symptoms.

The proper treatment for both gonorrhea and chlamydia worldwide, including India, is an injection of ceftriaxone (250 mg, sometimes 500 mg) plus either a single oral dose of azithromycin (1 g) or doxycycline 100 mg orally twice daily for 7 days.  (Minocycline can be substituted for doxy.)

[SBINDIA]

You may opt not to answer above question during this holiday session and lot of query in line. I got the answer from this link:

as my partner gonorrhea was newly diagnosed.

http://www.medhelp.org/posts/HIV---Prevention/Extremely-worried-about-HIV-Please-help/show/2150731#post_10256740

Where you mentioned:

"While you're at it, have a urine gonorrhea/chlamydia test and a syphilis blood test."

I plan for that and let you know.

[SBINDIA]

Now with the above information what test do you think I need to plan? is it a blood test or urine or virginal discharge test?( I have no discharge now)

[SBINDIA]

No My partner gonorrhea symptom started from 10th Feb (we had sex on 9th Feb) and he think that he is acquired it most likely from his exposer on 31st Jan. Before that he didn't had gonorrhea.

Yes my partner had visited expert.

He took an urethral smear gram stain test on 14th Feb indicated a large number of pus cells and intracellular gram negative diplococci seen.

1. Is this test was not find chlamydia? if it was there?

He treated with: Azithromycin (500 mg) and Amoxicillin (500mg) | Clavulanic Acid (125mg) by the doctor.

After that we didnt have sex and my problem  started on 1st April  onward.

Thank you so much doctor.

[H. Hunter Handsfield, M.D.]

Hmm -- perhaps I misunderstood.  You originally said you had sex with your partner on Feb 9 and the next day he told you he had gonorrhea.  Did you mean he had gonorrhea at that time, i.e. was diagnosed and treated on Feb 10?  Or did you mean he had gonorrhea sometime before that?  How long ago?

If his gonorrhea was newly diagnosed, then you definitely need to be tested and treated for it, and also for chlamydia.  Up to 40% of people with gonorrhea also have chlamydia -- so your partner also may need chlamydia treatment, since amoxicillin is only for gonorrhea.  (And it's actually a very poor gonorrhea drug as well.)

Therefore, based on all the information as I now understand it, I recommend that both you and your partner be tested at this time for chlamydia and gonorrhea.  All your energies seem focused on HIV and syphilis, but gonorrhea and chlamydia are far more common and should be your highest priority, especially given your vaginal discharge.

It appears that neither you nor your partner has seen an STD expert.  Excellent STD services are availalble in India, at least in most major urban centers.  I recommend you and your partner both find a doctor or clinic with STD expertise and then follow their advice.

Please stop asking about HIV.  I have told you twice that the tests prove both you and your partner do not have HIV.  The negative VDRL test is conclusive as well, so no more worries about syphilis.

[SBINDIA]

Let be specific, otherwise it becomes lengthy.

1.Do you thing my partner has HIV or he is clear? with all the above information? He has unprotected sex with CSW and take test after 5 week less than 1 day?

2. I do take VDRL slide test after 1 month of the sex with my partner. No treatment or medicine I have taken.

3. Do you thing my lower abodomain pain and verginal discharge may be out of gonoriha. which I likely get from my partner?

4. What type of further test do you suggest?

With that I want to close the thread and thanks for your time.

[SBINDIA]

No no test or medicine for gonorrhea.

[SBINDIA]

Sorry mistake in numbering:

5.4. Finding in report there is a HIV type 2 test when I asked the HIV expert what it is he just said " do not to worry much on that it is rarest possibility and latest data suggest prevailing rate is less than 1% in India of this type 2 and  very very infrequent, test all over the world is included this type 2. Not to worry if anything was wrong by 5 week it was detected and chance of infection in one exposer taking all this together tensed to zero. your partner is HIV free" do you agree with it with your vast experience and knowldge?

6.Now what I have to do test/medicine what is your suggestion?

Please provide me your advise all the above. Thanks for you kindness in advance.

[H. Hunter Handsfield, M.D.]

1) There are many causes of vaginal discharge, with or without odor.  Gonorrhea is among them.  You still say nothing about your own treatment or testing for gonorrhea.  I cannot help you without that information.

2-5) Just as with your other symptoms, discussed above, these symptoms do not suggest HIV, and your tests prove you do not have HIV.  Your and your partner's tests cover HIV2 as well as HIV1.  With the possible exception of vaginal discharge and odor, you symptoms have nothing at all to do with your partner's gonorrhea or other sexual partnerships.

[SBINDIA]

Dear Doctor

Thanks for your advise. I had taken a VDRL slide test on 10th March (exposer was on 9th Feb) along with the HIV test I mentioned above. Both was negative. No other test or medicine I have taken.  

My partner treated with Amoxicillin after discharge started from his penis which he said stooped within 2 days. He confirm that his exposer was high risk with CSW unprotected. Which he will not do again I know.

If everything remain OK I want to marry him because except his last high risk activities (which I know his first time) he is very caring and good person  who never tell lie.

Just we have to clear all this. Meanwhile previously when we sex we found whitish bad smell discharge from my vagina. I concern this is a long term problem remain with me. The whitish discharge increases if I travel a lot and during hot session.  

1.Is it I have any  long term problem or it is common for woman. Due to my nature of work (I am working in shop) where same wash room are used and I failed to maintain good hygiene.    

2.Meanwhile I am finding very odd smell out of mouth is it related with this. Please tell me what is your advise. I failed to took food at proper time I have low blood pressure.

3. I consulted with an local HIV expert between this time out of anxiety(till I didn't get your confirmation) he also mentioned that the HIV test is at par with the anywhere in the world and do not to worry. You agree with that I have provided the exact thing written in the test report. i.e" Detection of HIV P24 antigen and antibody to HIV type 1 and/or type 2 , architect abott, Chemiluminescent Microparticle Immunoassay (CMIA)"

4. My partner took the HIV test approximately at 5 weeks( less 1 day) after his high risk exposer mentioned above. Do you believe he is clear? can I marry him?

4. Finding in report there is a HIV type 2 test when I asked the HIV expert what it is he just said " do not to worry much on that it is rarest possibility and latest data suggest prevailing rate is less than 1% in India of this type 2 and  very very infrequent, test all over the world is included this type 2. Not to worry if anything was wrong by 5 week it was detected and chance of infection in one exposer taking all this together tensed to zero. your partner is HIV free" do you agree with it with your vast experience and knowldge?

5. Now what I have to do test/medicine what is your suggestion?    

      

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

You don't mention the most important information of all.  After the exposure and your partner's disclosue, were you treated for gonorrhea?  Were you tested for it?  And tested for chlamydia?  Syphilis?  If you were treated, what antibiotics were used?  If you were not treated, gonorrhea might be the cause of your vaginal discharge and lower abdominal pain.

Your partner's and your blood test results show that neither of you has HIV, so no worries there.  Other than vaginal discharge and abdominal pain, your symptoms are not of concern for STD.  Neither HIV nor other STD is a likely cause of the symptoms you numbered 2, 3, and 4.

Perhaps I will have more comments if you let me know about gonorrhea, chlamydia and syphilis testing treatment for gonorrhea. In the meantime, you need not worry at all about HIV; those test results are conclusive.

Best wishes--  HHH, MD

[SBINDIA]

Just forget to mention that during this period I had frequent bowel (each time very small amount) daily 6 to 7 times for 2 to 3 days and then slowing down over a period of 1 week.