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Series of Symptoms followed by Inconclusive Test, Please Help
Jun 1, 2009

Hi I'm a bi-sexual white male in my mid 20's, I've had a bit of an ordeal over the course of the last month or so; I visited an old friend out of town, who probably gave me strep, as I began to get sick shortly afterward. I went to the doctor, who noticed something wasnt right with my white blood count, and sent me to the hospital. They dismissed it the other doctors concerns at the hospital, gave me Amoxicillin, and that was that. (PLEASE bear with me, I'm sorry for the length) So, about a week into the Amoxicillin, I'm getting better, and suddenly I have a seizure at work (I was diagnosed with epilepsy after having 2 seizures in 2006, havent had any since. The seizures I had then were also preceded by bronchitis/pneumonia like symptoms). As I had the seizure at work, I was rushed to the hospital, where after having bloodwork done, ER doctor sat down and asked if I had been checked for HIV and he was concerned about my white blood count. (In the mean time, my neurologist put me on an anticonvulsant-keppra-shortly after I started this I began to break out in a strange rash. The neurologist didnt think it was rrelated to the keppra but advised to stop taking it anyways.) A week or so after the seizure, I scheduled an appt. with my family doctor, who had a CBC done; I was called about a week later to come back in, as he was now concerned about my white count not yet coming back up. As a precaution he had already went ahead and had a HIV western blot test done, which came back inconclusive. A following one was also inconclusive. Its been a long stressful week I've waited now to hear back from the doctor. My rash is still bothering me slightly, it is not severe and will pop up only breifly, as in spots will appear for minutes at a time and go away. I also have a swollen lymph node - I think - on the left side of my groin for about 2-3 days now. It does not bother me really, other than the first day; by the second day it had drained small amt. of blood and is smaller now. I have had unprotected sex with a male friend who I know well, and trust that isnt positive, but I havent spoken with him in over a month and can't reach him for some reason. I don't think he is positive, but Ive been sort of preparing myself for bad news when I hear back from my Dr. If I'm positive or not, this has bene a life changing week for me, incredibly stressful. I've not been able to do anything well, from school to work to sleep, i'm really, really, scared. Do you think all my symptoms indicate I'm in for a positive diagnosis, from what you've read here at least? Sorry for the length, I wanted to fill you in on everything, thank you so much, this is a Wonderful site.

Response from Dr. Frascino

Hello,

I'm not going to be able to sort out all your problems over the Internet, but I'll certainly try to point you in the right direction.

Regarding HIV-acquisition risk, you had unprotected sex. By definition this places you at some degree of risk for STDs, including HIV. Consequently HIV testing at the three-month mark is warranted.

Symptoms are notoriously unreliable in predicting who is and is not HIV infected. The reason for concern and HIV testing is HIV risk exposure, not the presence or absence of symptoms.

Regarding HIV testing, if your doctor ordered a Western Blot test without first getting an ELISA test that was repeatedly reactive (positive), he ordered the test inappropriately! Western Blot tests should only be done to confirm a positive ELISA (or EIA or rapid test). What you basically need is an ELISA test three months after your last potential HIV exposure. If you are concerned about your indeterminate WB tests, get an ELISA now. Chances are quite good it will be negative. You'll still need a three-month ELISA for a definitive result.

Regarding your epilepsy, if your neurologist didn't think your anticonvulsant drugs were causing your rash, why did he stop the medication? Someone needs to follow up with what you need to do next regarding your rash (see a dermatologist) and your epilepsy (do you need a different anticonvulsant or different neurologist?).

It seems to me your general medical care has been far from comprehensive or optimal. You might consider seeing a general internist who could better coordinate your care and who hopefully would be better versed on appropriate HIV screening.

Good luck.

Dr. Bob



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