Please help with my situation, need expert advice.
Feb 21, 2012
Hi Dr McGovern, I am a 27 y.o otherwise healthy female, my situation is kind of complicated and in short I think I may have been exposed to HCV via unprotected sex with a male partner who a month after the fact looked like he was going through an acute hep phase, refused alcohol, and appeared severely jaundiced. I was potentially exposed on November 9th, 2011 and about two weeks later came down with a bad flu-like condition that lasted about two weeks and then developed into something that I am still dealing with 3 months down the road. I had fever, severe sweats, but also notably liver pain. At that time the thought of having hepatitis did not even cross my mind, I was more concerned with HIV and got my partner tested with an instant test, which came out negative. I am no longer in contact with this person. Into December I am still feeling severely fatigued, have really bad neck pains, enlarged lymph nodes (over 2 cm), some stomach discomfort, loss of appetite, and RUQ pain. I also came down with bladder pain which later turned out to be a UTI, which was treated and since then I feel like I urinate much less than usual, my urine has a smell, is cloudy and I was later diagnosed with proteinurea. My doctor has done all the metabolic tests (incl LFTs) & CBC on numerous occasions (about 4 and 7 weeks post exposure) and everytime the tests are negative. I also had an abdominal ultrasound done mid December which was completely normal. I have had a thorough workup by an ENT in January who tested me for HIV, mono, CMV, cat scratch, lyme, etc, all to be negative. All STD tests were performed as well, also negative. I then went to an infectious disease specialist in Feb who ran a lot of tests on her end, including hep A, and C anti bodies at 3 months post-exposure, all negative, LFTs again normal. I have been vaccinated against Heb B in the past so I am not worried about that. Now end of Feb I have been feeling better but have recently developed even more pressure in RUQ, my nausea is slowly dissipating and appetite coming back to normal but now I am developing some itching. I am still thoroughly concerned about acquiring HCV in light of my partner at that time being in what I am assuming was an acute phase, and I read that it is easily passed on at that time. Again, my LFTs and all other bloodwork have been normal throughout these 3 months, my last HIV and Hep anti-body tests have been done at 14 weeks post exposure, all negative, so were LFTs. My RUQ feels like its about to explode with pressure, but all the doctors who felt that area said liver was of normal size. Also, they refuse to give me a HCV PCR test simply because my enzymes have always been within limits and my HCV antibody would have been positive by now according to them. I will wait till 6 months post exposure to have my final tests just to be safe but in your opinion, how likely do you think it is that I have HCV given that Im negative into 14 weeks for antibodies but have severe symptoms that are indicative of an infection? Do you think my symptoms can be attributed to HCV or is there something else going on? Do you think that at this point I still need to get a PCR done, or should I just wait till 6 months? I appreciate your help.
Response from Dr. McGovern
I do not doubt that you are not feeling well. But if your right sided abdominal pain were related to hepatitis, your liver tests would be abnormal.
I strongly doubt viral hepatitis is the cause of your symptoms.
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