Is P24 antigen test post 45 days of exposure conclusive?
On 18th December, 2015, I had unprotected receptive oral sex (fellatio) and unprotected receptive anal sex (I'm a gay).
Around one and a half months later, I started to suffer following symptoms-
1. Extremely dry mouth (dry to the extent that it sometimes hurt to swallow saliva). This lasted around 8-10 days and resolved spontaneously.
2. Intense anal itching, pain while excreting and tiny blood spots on stool. Pain while excreting and blood spots resolved spontaneously after 4-5 days but itching continued.
3. Subsequently, I started feeling some vague symptoms like body pain, mild joint pain and tiny skin rash (picture attached) etc.
I consulted a doctor on 10.03.2016 who, got the following tests done-
1. Complete Blood Count
2. HIV P-24
4. Urine Test &
5. Stool examination (All the test reports are attached herewith)
The doctor gave me following treatment-
1. Azithromycin 500 mg OD for 3 days
2. Ciprofloxacin & Tinidazole 500 mg BD each for 5 days.
Though, symptoms didn't resolve and I consulted another doctor on 27.03.2016 who without any diagnostic test gave me Ceftriaxone 1 g IM and thereafter, anal itching resolved within a day or 2.
However, I'm still feeling joint pain (both knees, left ankle, left wrist and right shoulder) and it appears to be increasing. Sometimes, it feels in one joint and sometimes in some other. Also, there appears to be very mild swelling in left wrist. Further, sometimes I feel having some vague symptom like fatigue, mild fever and tachycardia.
What condition this could be?
HIV 1 and syphilis ruled out.
Welcome to HCM.
Thanks for posting your query.
Your P24 antigen test and VDRL one and half months after the risk exposure are reliable. So the possibility of HIV 1 and Syphilis were excluded. STDs are more than 25-30 in numbers. Your stool results showed the presence of E.Hystolytica.
That could be a reason for the blood in motion. You had responded better to Ceftrixone injection revealed that you could had Gonococcal pharyngitis or proctits which responded well to treatment.
You had Azithromycin and CIPRO with Tinidazole would have taken care of any other protozoal , bacterial infections and also chlamydia. Your joint problem may be due to reactive arthritis due the presence of infection it would subside after sometime with treatment.
Safe sex is better for your future. Follow the advice of your physician and there seems nothing serious to worry.
Thank you very much, Sir, for replying to my questions so wonderfully as you always do. In the past too, you had helped me with your vast knowledge and immense experience. I would also like to meet you in person at a feasible time.
However,presently,I would like you to help me for my concerns as mentioned below-
1. I had the exposure on 18.12.2015 and P24 Antigen test on 10.03.2016. As it is known that P24 protein peak at around three to four weeks after exposure to HIV and are usually not detectable after five to six weeks (and sometimes even earlier),it is possible that I'm HIV-positive but the test could not detect the P24 protein because I was infected more than four to six weeks earlier. In this scenario,Should I go for an antibody test or can I rely on P24 Antigen test result.
2. It appears that I had got infected with the Anal Gonorrhea,since,my possible Proctitis/anal itching responded immediately to Ceftriaxone.
But,since,I had the symptoms like joint pain,tiny skin rashes present before starting the medication,is it possible that my Gonorrhea infection had disseminated/had started disseminating before taking medication and for that reason,treatment with 1g IM Ceftriaxone was not sufficient and it could treat only mucous membrane infection and not the systemic infection (Treatment with Ciprofloxacin and Azithromycin may be ignored as they are no longer recommended since there has been sufficient resistance noticed).
How to make sure that it is just Reactive Arthritis or something else trivial and not the Disseminated Gonorrhea Infection.
Thanks and Regards.
Unlikely to be due to disseminated gonorrhea
Hi, Welcome back.
P24 antigen will be persist for 3-6 months after the infection. Would not disappear within weeks.
Disseminated gonorrhea is not common in this Era of antibiotics. Blood culture test for gonorrhea will reveal the presence of disseminated gonorrhea. Fever will be a invariable feature of disseminated gonorrhea.
Your problem is possibly due to reactive arthritis.
Dr S Murugan
Please reply conclusively that whether I should go for a blood culture test. Further, please intimate that should I take 2-3 days IV medication empirically in order to avoid possible complications (gonococcal endocarditis, meningitis etc.) as blood culture test also gives false negative results sometimes for DGI.
Follow the guidance of your treating physician
I don't think that you need a blood culture. Unnecessary treatment is not indicated. It is up to the treating physician to decide the same.
Dr S Murugan
Thank you again Sir for replying to my concerns.
It is to intimate that right now I'm not getting treatment under any physician. The physician I visited on 27.03.2016, told that since I was not suffering from anal discharge, I'm unlikely to have Gonorrhea, however, since, I was suffering from anal itching, he prescribed Ceftriaxone only (possibly empirically) and didn't feel any need for follow-up. (Though, anal itching subsided immediately after treatment raising the concern that I might had Gonorrhea.)
However, I'm concerned about the mild joint pain which has been there for one and a half month now (pain in left wrist subsided now and a little pain only left in knees only) and tiny skin lesions on my arms and legs (picture attached) which also started appearing one and a half month earlier( they erupt and heal in almost a week's time and then new lesions erupt and so on).
Kindly reply point-wise-
1. Is it possible that the arthritis and dermatitis relating to DGI persist for more than a month?
2. Is it possible that the treatment with 1g IM Ceftriaxone could clear mucous membrane infection and NOT the DGI in MY CASE?
3. Is there any STI other than Gonorrhea which causes anal itching and responds to Ceftriaxone?
Kindly reply that whether I can forget this incident.
Ceftrixone is effective against bacterial STDs and nonsense.
Since 20 years I had not come across a single case of DGI. It is not common nowadays.
1. DGI is an acute condition need hospitalization. It is quite unusual to have arthritis and dermatitis due to DGI to persist for a month as it needs intervention immediately.
2. Single injection of Ceftrixone cannot cure DGI. It is not true that it will cure rectal gonorrhea while DGI persists.
3. Ceftrixone is effective also against Syphilis, Chancroid apart from gonorrhea and also in other bacterial conditions other than STDs.
Dr S Murugan
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