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Reiters Syndrome.

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Dear all,

I had gonorrhea infection almost 5 months ago. Witch was treated from second time (first time was not successful) but in last 3 and a half months I am experiencing strange symptoms, joint pain, underarm pain, shoulder pain, red dry eyes, tingling in genital area and tongue, small painless skin nodule under left breast, painless mouth ulcers in bottom of mouth for last 2 months, white tongue, small red dots on tongue and occasional throat pain. Diarrhea from time to time.
I have done all STD tests again witch was 3 and a half month after exposure and they came back negative. Should I still worry about STD (HIV, Herpes...) or something else is wrong with me? I have done more tests like ERS, C-Protein, RA Factor and they came back as normal. In my CBC Eosinophilis are 13% and WBC is little higher.

Category: Infectious Disease Specialist

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Category: HIV- AIDS Specialist
 19 Doctors Online

Hello and thankyou for approaching DoctorSpring with your query.

From the symptoms you have described and from your case, you are possibly suffering from 'Reactive arthritis' earlier known as 'Reiters syndrome'
The classical triad of Reactive arthritis is -
1) Urethritis (presents with difficulty in passing urine due to pain or burning sensation, Watery or mucoid discharge from the penis, Urethral opening at the tip of the penis is red, swollen or itching)
2) Uveitis ( inflammation of the middle layer of the eye, causing redness of the eye)
3) Arthritis ( Pain in the joints, swelling, warmth, redness may be present)
Patient can present with diarrhea and mouth ulcers too.

Another possibility is an autoimmune disease which is unrelated.
. . . .

The sexually transmitted organism Chlamydia Trachomatis is the most common cause of this disease.
Increased eosinophils and raised WBC count is seen in chlamydial infection. 'RA' factor will come negative in case or Reactive arthritis.

I would advise you to go to the medical center and get the following tests done.

1) Nucleic Acid Amplification Test (NAAT) for chlamydia.
2) Test for HLA -B27
3) ANA (If ANA is already done please let me know the results.

For now you will need symptomatic management. This is better managed under the care of your Doctor. There is a good chance that the symptoms will resolve on its own.

You need not repeat the other STD test if you have already done so.

Feel free to follow up with any queries.

I hope this has helped.

Thankyou


Patient replied :

Thank you, when I was treated for gonorrhea first time I was given azithromycin 1 gram with ceftriaxone shot and second time doxycycline 7 days 200mg per day with gentamicin shot. I assume that this would clear chlamydia as well?? Am I wrong? Would Reactive arthritis show some inflammation in ERS and C-protein test? Should I still be worried about viruses considering my high Eosinophilis count ?


Hello,

Yes Doxycycline and Azithromycin are effective in Chlamydia and it should be taken care by them (If there was a Chalmydia in the first place). But in reactive arthritis the infectious agent is not directly responsible for the symptoms, rather the immune reaction is. So it is still possible.

ESR, CRP etc can be high or even low in some cases.

The features are not very typical of reactive arthritis, but it would be the first possibility to considered. You seem to have certain features of an autoimmune disease. A single straightforward diagnosis could be bit difficult. And it can be frustrating too ! That is why a step by step approach is important. Do get an ANA test done (if not done already). You should be getting symptomatic treatment now.

The important thing is NOT to focus solely on the STD. As I said earlier it could related or unrelated to it. And most probably your STDs will be cleared by now.

Hope this helps
Feel free to ask followups / clarifications. (You can also share investigation reports)
Thank you


Patient replied :

Hi, it has been 2 months but i have done ANA test in the lab but i don't understand the results.
(ANA) elisa 0.76 i.value < 0.8


Hello, I see a blank followup question. Did I miss something ? Please edit or add if you have more queries. I will be happy to help.

Thank you

The result is negative.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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