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PN related question : Follow up
Aug 13, 2011

Hi Doctor Bob, hope you are well. I wrote to you last December and you had answered my questions then. Let me first give the link to that question. http://www.thebody.com/Forums/AIDS/SafeSex/Q212396.html I will also summarize it to save you some time: Possible exposure in March 2007 in Cancun, Followed by a penile fungal infection (Thats what the doctor said it was) with itching and burning on the tip but no problem in urination which lasted for many months, then 6 weeks post exposure I had dry cough, dry mouth as if no saliva at all for 2 weeks, night sweats, lack of appetite, itching all over mainly palms. NO fever,swollen glands, diarrhea, headache, fatigue or muscles pain ever though.

Tests taken: Elisa 1& 2 after 3 months and 6 months, EIA 1 &2 after 10 months, syphilis test after 2 and 10 months, Hepatitis B and C antibody test after 8 and 10 months, Herpes IgG and IgM after 2 and 10 months, Rh factor test (4.7). All the tests were negative. CBC taken thrice during this interval and WBC count fluctuated between 6000-7200 with lymphocyte count between 36-38%.

Now my problem was that while all other symptoms which begin after 6 weeks subsided within a month but I later had some swollen glands (not sure if they were glands) inside both the armpits which alter turned into cording and then became alright quickly but since then from time to time I still feel stickiness and discomfort in the armpits. Apart from that, 8 months post exposure I started to have burning in both my feet and sometimes on my palms as well. My doctor initially advised me to take vitamin b12 pills which I did for 2 months but the systems are still persisting after more than a year of that exposure. They do vanish from time to time but comes back again. 2 months back I went to a neurologist and he thought it was PN based on symptoms although all my reflexes were normal as per him. He gave me an anticonvulsant (pregabalin) and I was perfectly alright after that for a month but then the symptoms came back and this time there is no burning but all my fingers and toes are paining. You say HIV related PN first affects the toes but in this case it started with the soles and now the toes and fingers are affected. I do not think I had that much anxiety and stress after my negative test results so not sure if anxiety can cause this.

I have also taken tests to rule out any liver problems, diabetes or thyroid issues. There is absolutely nothing left in the books which can cause these PN symptoms. So my questions to you are:

1) Do you think I should get further HIV testing? I know 3 month test is considered conclusive but this time may be for other strains like N and P if possible? Does these ELISA and EIA 1&2 tests detect the antibodies for such strains? 2) Did I miss testing for other STDs like HPV, Chlamydia etc based on my symptoms? I recently married and so I am now more worried about all this. 3) Do you think what I am having is HIV related PN? 4) Just out of curiosity, have you ever come across someone who had negative antibody tests after 6 months of exposure and later developed AIDS due to known reasons such as simultaneous acute Hepatitis C infection or otherwise? 5) Does my lymphocyte percentage (36-38%) which is on the higher side indicate that I do have some viral infection for sure?

Thanks doctor Bob. You have been kind enough to answer me the last time; I hope you answer me this time as well. My best wishes and prayers are always with you. Take care

Response from Dr. Frascino

Hello.

Thanks for including the reference to your previous question, as this helps me quickly review what we've discussed in the past.

Responding to your current questions:

1. No. You are definitively HIV negative. No further HIV testing is warranted.

2. No.

No, definitely not.

4. No.

5. No.

Unfortunately I cannot diagnose the cause of your symptoms over the Internet. However, what I can do with great certainty is advise what's not causing them: It's not HIV! I would suggest you follow up with the neurologist for further evaluation and management of your painful hands and feet. If no physical cause for these problems can be determined, you could consider getting a second opinion from another neurologist. If a physical cause still cannot be determined, you should be evaluated for psychosomatic illness. Psychosomatic disease causes very real symptoms.

Good luck.

Dr. Bob

Is it PN and should I stop considering HIV as a cause of these symptoms? Dec 12, 2010



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