Help! No one can figure out what is wrong with me

[asikp]

Please help - no one can figure out what is wrong with me.  

On 9/30, I received unprotected oral sex from a woman who apparently had gonorrhea of the throat.  Although I was asymptomatic, I was worried about the exposure so I got tested for a full battery of STDs.  I tested positive for gonorrhea.  On 10/14, I was prescribed a one-time oral dosage of Azithromycin and Suprax, which I took that night.

Soon after taking those medications, I began experiencing a number of odd symptoms - fatigue, low-grade fever, sore throat, joint and muscle pain, shooting pains all over my body, back pain, and pain in the upper right quadrant of my abdomen.   I was initially worried this was ARS, so we tested for HIV on the 27th day after exposure (and again on the 42nd day).  Negative.  We also re-tested for gonorrhea and for syphillis, also on the 27th and 42nd day after exposure.  Both negative.

On the 34th day after this expsoure, we did a blood draw to look for markers of other issues.  Everything looked fine except one of my liver enzymes was slightly elevated (66 ALT) and my platelet count was just barely over the high end of normal range.  Out of an abundance of caution, my physician ordered a full hepatitis panel.  Everything came up negative.  We then tested again on the 42nd day for Hep B and Hep C - again negative.

Still unable to figure this out, I had an ultrasound on the right-upper quadrant of my abdomen about a week ago.  Everything looked normal.

Over time, my symptoms have evolved a bit, but they aren't going away.  Currently, I am experiencing:  fatigue (I need 9-10 hours of sleep per night), malaise, weight loss (I've dropped 13 pounds in 7 weeks), dull pain in my abdomen (particularly right upper quadrant, but not exclusively), occasional shooting pains throughout my body, fogginess/inability to concentrate, constant back pain, rib soreness, feelings of dehydration (no matter how much I drink), and (starting yesterday) intense shooting pains in my left testicle (7-8 times for maybe 2-3 seconds over the last 36 hours).

My PCP basically told me to see what happens over the next 10 days and see how I feel at that point.  I am completely at a loss, and it sounds like he is, too.  Given the repeated tests, I don't think I'm dealing with something sexually acquired, but I haven't clue where to turn next.

Please help!

[mkh9]

At this point I don't see that is points to an infectious disease. Perhaps you might want to see a gastrointestinal specialist. I know it seemed come on around the time of your exposure. Like you said it isn't an STD and doesn't sound like Hepatitis. You can rule it out but your symptoms don't point towards an infection.
Regards,
mkh9

[asikp]

Thanks, mkh.  I will definitely test again for Hep B in a few months, but that seems extraordinarily unlikely for numerous reasons:  uncommon disease in heterosexuals in the US, miniscule rate of transmission through insertive oral sex, high vaccination rates (I haven't been vaccinated but the woman was in her early to mid 20s, and it is unlikely to be showing all of these symptoms if antigens weren't yet evident in my bloodstream).

As to your other questions, I have no issues with urination, and I had a urinanalysis done, too.  It also showed no abnormalities.

At various points my stool has looked odd (almost hairy), but only one or two instances of diarrhea in 50 days.

[mkh9]

I agree that it is not likely an STD. When i was thinking about STD's, I was worried about resistance to antibiotics not chronic infections and I didn't know it was oral sex. I tend to ask particular questions for a reason. Usually, to rule out things. Sometimes I find some things are missed, or I am collecting information to understand your situation. I am not a doctor I am a microbiologist and see things in a different way. Anyway, I guess at this point I would retest the hepatitis in a couple of months perhaps. But other than that it doesn't sound infectious. The scan you had ruled out a gallbladder problem and so forth. Sometimes pain does radiate from the kidneys to the front. Just because you has a slight elevation in liver enzymes, a lot of things do that. I wonder about a kidney infection? You don't have any problems with burning on urination or frequent urination? Still sometimes they can be high up. Did you have a urinalysis? It would also check for various things like crystals, casts, White blood cells , general infection markers are leukocyte esterase and nitrate.

The Gallbladder liver and kidney ultrasound may not pick up an infection as it looks for structural abnormalities. This doesn't explain the weight loss though. So, have you had any diarrhea? gone swimming in fresh water? Anything odd like travel eaten out and had a problem after that? I am trying to find a source of what could be your problem.
mkh9

[asikp]

I took HIV duo at 27 and 42 days.  I'm in the clear for that.  Syphills seems incredibly unlikely.  Very hard to catch, and even with a 20% false negative rate, I've been tested by two different labs.

[asikp]

I do not have any of the most notable Hep B symptoms - jaundice, clay stools, dark urine.

[asikp]

I mean is NOT a typical STD

[asikp]

Thanks so much for your response, but I'm pretty certain that what is causing my current symptoms is a typical STD.  

I've tested twice for gonorrhea - from separate labs - since taking the Suprax and Azithromycin, and have been negative both times.  Moreover, there are no known cases in the U.S. of persistent gonorrhea after those antibiotics and I didn't have sex during the time I was recovery.  Same with chlymidia.  Negative twice.

I've tested negative for HIV and syphilis both 27 days and 42 days (separate labs) after the exposure.  I also have no signs of syphillis and it is rarely transmitted through insertive oral sex.

That would leave only Hep B as a possibility, but Drs. Hook and Handsfield, whom I surveyed at their new site are quite certain that I didn't acquire Hep B from insertive oral sex (only a theoretical risk), and my PCP says there is virtually no chance that Hep B could be causing all of these symptoms while not showing up on a blood test.  To be sure, the incubation period for Hep B can be up to 6 months.  But an incubating virus shouldn't be causing all these symptoms and the research I can find online suggests that liver enzymes don't elevate until after the body is producing antibodies - long after antigens would be detected.

Drs. Hook and Handsfield are fairly emphatic that what is making me feel unwell isn't sexually transmitted.  So what the hell is it?

(I should note that the testicular pain I felt the last 36 hours is almost an afterthought.  By far the most prominent symptoms are fatigue, back pain, and abdominal pain)

[mkh9]

From the CDC symptoms of Gonorrhea can have scrotum pain. So I wonder if you still have it even though you tested negative. See link below and paraphrase:
http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm

What are the signs and symptoms of gonorrhea?

Many men with gonorrhea are asymptomatic 3, 4. When present, signs and symptoms of urethral infection in men include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.

I don't think that is causing the weight loss but stress could be. Some times gonorrhea can get into other areas and cause problems as well. Do you have a fever?

I would think about getting a culture and/or another PCR or molecular based test to see if it comes up positive again.

Were you also tested for Chlamydia and Syphilis? Or which STD's were you tested for? Gonorrhea has a tendency to come up negative sometimes. Or it can become resistant to the antibiotic. It may be something else as well.  What country do you live in?

For hepatitis the window is about 45-160 days for Hepatitis B (unless you had the vaccine then it doesn't matter). Hepatitis C is about 6-10 weeks before the antibodies show up. So you may want to retest.

Have you had any rash on your hands or feet? Such as brown patches or reddish brown spots? Secondary Syphilis can have these types of symptoms and if you weren't treated for it , it can cause weight loss as well. The RPR test has 20% false negatives. So getting tested with an alternative method might be a option for you such as the FTA-AB (antibody) test. Some countries have a false positive for some diseases that is why I asked where you are from but also asked because I wanted to see if you could have been exposed to a parasite.

Which HIV test did you have? If it was a 4th generation duo assay you are clear of that. As you took that at a very good time and that is the best test out there.

Your original symptoms may have been due to a reaction to the antibiotic so  I would go with your current symptoms.

Do you have any yellowing of the eyes or skin?

Okay, that is all I can think of for now.

take care,
mkh9

[mkh9]

p.s. I see you are from the U.S. so you could get the FTA-AB test and there won't be any false positive reaction since this would be in other countries (unless you traveled recently).
mkh9