Oct 17, 2004
hi Dr. Conway:
I have a very long story to tell. My case seems to be similar to Karen's case. I was in Bangkok last year in July and had protected sexual intercourse with 2 different prostitutes. My condom got torn with one of them. I also had unprotected oral intercourse with them. After a few days, I came down with a bad flu-like illness and it took 3 weeks for it to go away. I got tested at 6 weeks at a regular lab in my city in the US. My problems started after that and I started getting evening rise of temperature as well as chills which continued for 4 months. I got tested again at 3, 4, 5, 6 months with the home access and the Oraquick test and all were negative. After a few days I developed severe dysuria but my WBC counts in urine were normal. I was given many antibiotics even though my urine culture did not show anything but nothing worked. After all this my doctor ordered a tuberculosis ELISA which showed raised IgM and I was given antituberculosis therapy and my dysuria went away. I continued the therapy for 4 months and had to discontinue it as I developed peripheral neuropathy even after pyridoxine supplementation. I also had a Roche Amplicor 1.5 done at 8 months which could not find the virus and I got a CD4 cell count test done which showed CD4 606, (35.3%), CD8- 368 (21.3%), ratio 1.65. After this, I got a oraquick done at 14 months which was negative also. My symptoms don't seem to come to an end as I still have peripheral neuropathy and severe backache as well as pain in my legs. I still don't know what to do right now. pls help me. thank you.
Response from Dr. Conway
Well, the first thing you can do is forget about HIV. Your immune system is intact and there is no evidence of the virus or a reaction of the body to it. Therefore, the exposures you describe in Thailand did not lead to the transmission of HIV infection. The only reason for you to consider any more testing is if you think you may have been exposed to HIV more recently, by another exposure.
Now, the symptoms you describe (especially the dysuria) may be due to another sexually transmitted infection that may not be detected on a urine test. Therefore, I would hope that at some point you received treatment for gonorrhea and chlamydia. I would also want to make sure you were tested for syphilis and received treatment if the test result were positive.
I am not sure exactly what test was done to figure out that you had tuberculosis, but if this is the diagnosis, 4 months of treatment is not enough. There are other treatments than INH that would be available to you that do not cause peripheral neuropathy, so you should discuss this with your doctor. Incompletely treated tuberculosis could certainly cause persistent symptoms of the type you describe.
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