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HIV+ and issues with responding to STD treatment

Sep 29, 2012

In the past several months, I have made some poor decisions about anonymous sexual encounters. Oral sex without condoms was exchanged. In May, I was diagnosed with Syphillis, was given Penicillin shots. In July, I was tested to determine if treatment worked. My Dr. was satisfied with the Titer? results. Now, 3 weeks ago I tested positive for Chlamydia and was given the 1,000 MG Z-pack 1 dose. After 7 days, still had symptoms (discharge and irritation while urinating), went to my regular Dr. tested positive for Chlamydia and was given 2 weeks of (twice daily dosage) of Doxycillin. 3 weeks later symptoms have been reduced but still clear discharge and irritation. (Tested neg for ghonorrea with both tests). Dr. wants me to continue with Doxy for about 2 more weeks. I'm Hiv + since 2006,undetecable as of Nov. 2011 and good %'s (sorry can't remember the %) CD 4 count was close to 400. On Atripla and Acyclovir (double whammy genital herpes) taken regularly. Dr. thinks I may have another bacterial STD that is more tricky to treat. He happens to be one of the top infectious disease specialists so I am certain he is being thorough. But very worried about why I am not responding to the treatment and what if I don't respond after two more weeks? At my last visit, my Dr. came down on me very hard about my choices and just made me feeling even way more worthless than what I was already feeling. I know what triggered my bad choices (and am totally abstaining from sex right now), but am trying to understand the lack of response to the "regular" treatments for the STD(s). Any insight or enocuragment to hopefully put my mind at ease and try to move past this would be much appreciated.

Response from Dr. Wohl

Other than the chlamydia, your syphilis, herpes and HIV are responding to treatment. So, really, this seems about the chlamydia. I am not sure why you are not responding appropriately to antibiotics. Some cases of chlamydia do indeed require prolonged treatment and that is what seems to be happening now.

Further testing for other possible infections makes sense and it seems this is a work in progress.

Abstaining from sex so as not to muddy the waters is smart. Reflecting, as you are, on how to avoid infections such as this may also be helpful to you. Clinicians want to make people well. We get satisfied with cures and treatment successes and we get frustrated when what we do does not work. Your clinician is human and is obviously vexed that he/she is having to play STD whack-a-mole in your case. That you have a stubborn infection only makes things more intense. The doctor-patient relationship, like most human relationship, is complex. Honestly is essential to you and your doctor making the most of your bond. Feel free to share your thoughts while acknowledging your understanding of how he/she must also be feeling.


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