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Dr. Bob, Medical Doctor
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I had a very risky (And stupid) exposure (receptive anal

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Hello Doctor!I had a very risky (And stupid) sexual exposure (receptive anal with blood) just over 4 months ago (On April 2nd, 2017). One week after the event, I got scared, and so I was tested for all STD's, including Hepatitis, and all results came back negative. I again tested 3 weeks after the event for all STD's and all results were once again Negative.Approximately 1 month after the exposure, I began having horrible abdominal pains, and at this point, a doctor had told me that my liver felt slightly enlarged. I was tested for all STD's from Labcorp, and eventually, at the 6 week mark, Hepatitis B Core Antibodies became positive. A week after that, I took an "Acute Hepatitis B blood test", and according to those blood tests, I was already Surface Antigen Negative, Core Antibody Positive, and Surface Antibody Positive (>1,000) at 7 weeks post exposure.I felt relief, but my problem, however, is that I'm still experiencing persistent abdominal pains 3 months later! The pains are only there when I sit down, and while they do feel as if they aren't as bad as they were when they began over 3 months ago, shouldn't they be gone completely already? I've begun worrying so much that MAYBE I also contracted Hepatitis C, but that maybe the blood tests I've had done just haven't picked up the RNA or the Antibodies yet? Since that time, I've had a Hepatitis C RNA Qualitative test done from Labcorp at 8 weeks (4 weeks after my abdominal pains began) and it was "negative/non-reactive". I've also had 2 more Hepatitis C Antibody Tests done from Labcorp at 3 AND 4 months post possible exposure, and both were also negative.On a side note, I've also had 2 HIV RNA QUALITATIVE tests done (at 10 days and 3 weeks) and 3 - HIV 4th Generation tests done, with the latest being done a few days ago at 4 months, and both were negative.Also on a side note, I'm a heavy drinker and smoker, and while I know this isn't good, it's been very difficult for me to quit while dealing with this stressful situation. Can my drinking and smoking heavily slow down the time it takes for my liver to recover an Acute Hepatitis B infection?On a final side note, throughout all of this, my blood Count and my Liver Enzymes have been checked repeatedly, and they have always been normal which led a few doctors to suggest I did not have Acute Hepatitis, which led me to get testing done at Labcorp and Quest Diagnostics.Thank you for any information regarding this and please let me know what my next step should be. Can I expect these abdominal pains to persist for several more months, even though my liver enzymes keep coming back normal? Lastly, I should add that I've even had a Colonoscopy done, and the doctor found nothing wrong in my large intestines which would be causing my abdominal pains.Thank you once again,
Richard W.

Hi Richard. This report is good. If you did contract HBV, you now have immunity to it. Your normal LFTs would suggest that the liver is happy and there is no ongoing inflammation. Anti-HCV tests are reliable, so you do not have this. I would suggest you get vaccinated for Hepatitis A, so you don't pick that up, and stop drinking alcohol (and cut way back on tobacco) to give your entire GI system a break. Your abdominal pain could be from stress, or possibly an infection with the H. Pylori bacteria, which can easily be tested for and treated. If no other diagnosis pans out, consider an UGI (upper GI) with "small bowel follow through" to look at the esophagus, stomach and small intestine. Your colon has already been cleared if your colo was normal.

Customer: replied 2 months ago.
Hello and thanks for your quick response Doctor!Regarding H. Pylori, I forgot to mention that 2 months ago, a doctor thought I may have Colitis (after describing my abdominal pains to him), and so I was prescribed a week's worth of Antibiotics; Cipro and Flagyl, but unfortunately these did nothing for my abdominal pains. Would H. Pylori require different Antibiotics? (These Antibiotics were prescribed before I had a Colonoscopy).Also, regarding my Liver Enzymes, they were never detected as elevated (I've had 4 CBC's with LFT's done in the last 4 months)...is this possible to have an inflamed liver from acute Hepatitis but with normal liver enzymes?Lastly, the abdominal pain I'm describing is just under both my left and right rib cages, and has been consistent for just over 3 months. It is only there when I sit down, but becomes almost unbearable when I do sit down. When I'm up and moving around or when I'm lying down and sleeping, then it goes completely away. Is it possible that somehow, due to the Hepatitis, that some "nerves" somehow became compressed and are being affected now when I'm sitting down?Thank you so much once again!
Richard W.

Cipro and Flagyl are the antibiotics typically used for diverticulitis, an infection in the lining of the colon. It is usually visible during colonscopy. H. Pylori is an infection of the stomach and/or duodenum and causes upper abdominal pain and/or burning. This would be worth testing for (there are blood, stool and breath tests, as well as biopsy via endoscopy) as it is easily treated with other antibiotics. If negative, or suspicion is elsewere, I would suggest a CT of the abdomen as this will provide other information about the upper colon, stomach, pancrease, liver and spleen, as well as the large blood vessels of the upper abdomen and the spine/ribs (in other words, a LOT of information). As for the liver, enzymes are almost always elevated with acute hepatitis, though the levels can change back to normal within a few days or weeks (so testing can "miss" the acute phase).

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Customer: replied 2 months ago.
Thank you Doctor! I just ordered an H. Pylori Antibody blood test. Hopefully the results are positive so I can get this taken care of, but If the results are negative, then I'll get scheduled for a CT Scan.Thanks again,
Richard W.
Customer: replied 2 months ago.
Doctor, I have a question regarding H. Pylori. I read online that the incubation period for this is 3-4 days...but this would be impossible in my case, as my abdominal pains began approximately 4 weeks after my possible exposure. Can the incubation period be longer than 3-4 days?

The incubation period can vary tremendously. Many people do not have symptoms for months, even years, after first contracting H. Pylori. Some do not develop symptoms at all, and become carriers.

Customer: replied 2 months ago.
Hello again Doctor. Regarding my earlier concerns, I've read online that during HBV/HCV coinfections, HBV can delay the "window period" for HCV serological markers. As I've mentioned already, I was tested for HCV RNA at 7 weeks (4 weeks after my abdominal pains began), and my latest HCV antibody test was done at 4 months, and both of these tests were negative, but yet again, I'll be taking another HCV RNA test on Monday to completely rule out Hepatitis C. Hopefully that will be negative again, and then I'll request an abdominal CT Scan.On a side note, I HAVE had bad neck and shoulder pains over the last 20 years. Are there nerves which run down for sides of the rib cage, which may have been compressed somehow during my acute Hepatits B? I've noticed that since acquiring these abdominal pains around my rib cage, my shoulder pain is almost nonexistent.Thank you once again doctor,
Richard W.

Hi Richard. Antibody production for HCV and even HIV can be delayed due to co-infection, but this is not common and usually occurs when the patient is quite sick. That said, tests at 4 months are extremely reliable. Anything negative after that is just an added level of reassurance. The abdominal CT is a good idea. As for the shoulder pain, whatever caused it has probably subsided. The body may have healed. Lower rib cage pain is typically not directly related to shoulder pain, particularly if it is on both sides of the body. If this persists, and the CT does not provide an answer, see a neurologist to work this up.