I suffer from chronic diarrhea and gastritis even with negative HIV tests. Why?

Hello,

Welcome to icliniq.com.

I am sorry to hear about your condition and will do all I can to help. It sounds like you are well versed in medical terminology and you have had some extensive testing. Since we are working with a new system that allows us to converse together for the next few days, I would like to ask you a few questions before I give you any advice about your problem. Can you let me know if that is alright with you?

My questions are, since all this started, have you been losing weight? Did your symptoms get worse after your antibiotic treatment? Have they changed over time? Have you ever noticed blood in your stool? Have you had any stool tests done? Has anyone looked into your colon with a light (endoscopy)? Are you married? What kind of work do you usually do? What is your diet like? Do you have a fever? Do you use any kind of drugs, smoke or drink alcohol? Answers to those questions will help me know better what is going on with you.

Hello,

Welcome back to icliniq.com.

Thanks so much for answering my questions. That makes helping you much easier.

Diarrhea can be caused by many different problems. It appears that your doctors have been trying to treat those problems and doing their best to help you. There are two kinds of diarrhea, acute and chronic. Chronic diarrhea is what you call it after patients have been experiencing diarrhea for over 6-8 weeks.

The most common cause of diarrhea is infection. As you have noticed, the initial concern was that you had contracted the HIV virus, which can cause chronic diarrhea when it has attacked the immune system for a long time. The fact that your CD4 count and HIV tests have been consistently normal makes the likelihood of that reason for diarrhea almost impossible.

Most viruses and bacteria cause diarrhea which is short lived. I would expect the stool test would have identified a bacterial cause. There are several parasites that can cause chronic diarrhea. Most of them should be seen in a stool test for O and P (ova and parasites). If you have not had that test, it would be advisable to get it.

Another cause of diarrhea is toxin induced. There is a bacteria called Clostridium difficile which can develop in people after they have taken antibiotics. That toxin can cause diarrhea for a long time. It would be very helpful if you could have a test done for this toxin.

Other causes of diarrhea can be found in the colon itself. There can be a polyp causing extra fluid in the stool, or inflammation (inflammatory bowel disease) causing mucus, blood and other watery stools. All these things can be best diagnosed by colonoscopy. There are many people who have dietary intolerance to lactose, (the sugar in dairy products and milk) and gluten (the protein in wheat and other grains). These problems can cause long term problems and usually clear up when the person stops eating those foods.

Finally, as you already mentioned, diarrhea can come from stress. Stress diarrhea is often accompanied by cramps, but does not usually wake a person up at night and does not cause weight loss. All of these reasons for diarrhea have good treatments which will help you get better. It may be that your diarrhea was started by one thing (the sexual encounter) but is now continuing because of another (stress, diet, Clostridium toxin). What do you think is causing it now? How does it interfere with your life? What is your course of study?

Hello,

Welcome back to icliniq.com.

I appreciate your answers. It is very natural to blame all your symptoms on the first thing that caused it. Unfortunately, after the length of time you have been sick, you may have symptoms left over from your treatment. I would definitely recommend that you have a stool test for Clostridium toxin and for ova and parasites. If those things are normal, I would try a month without milk products and without gluten. Eat a lot of fruits and vegetables, legumes and beans. Fermented soybean milk is good for restoring good bacterial in your gut. If you are not better in a month, you need to consider a colonoscopy. And of course, avoid people with COVID-19. Usually, parasites come from food or water.

I have never used the GI-map test. It sounds interesting and contains in it the stool tests I mentioned. If it is not too expensive for you, that would also be an option.

Hello,

Welcome back to icliniq.com.

If you contracted HIV two years ago, you would have tested positive by now, if candidiasis is coming from that. Most endoscopes show something, they tend to overread the results. If it was as done there, I am hesitant to see that is your problem. I also do not know what the red color was in your stool. I would recommend a stool test for blood to make sure. Have you been treated for the candidiasis? Both gastritis and candidiasis can and should be treated. But gastritis is not a common cause of diarrhea.

The stool test you sent me does not have your name on it (attachment removed to protect patient identity) Most authorities recommend two or three stool tests as passing parasites can be intermittent.

Hello,

Welcome back to icliniq.com.

The fact that your ESR (erythrocyte sedimentation rate) and complete blood count are normal is very comforting. I understand that you did not give your real name either to us or to the lab, and that is fine. The persistent candida infection despite treatment is puzzling, I must admit. How is your oral hygiene? When is the last time you see a dentist? Rinsing your mouth with a salt water gargle or baking soda gargle is one option to improve your hygiene and help control the candida. Yogurt capsules without lactose or lactose free yogurt would also help to replace good bacteria in your gut. As I said before, my recommendations are to start with investigations for Clostridium difficile and to repeat your test for ova and parasites. I would try the diet changes for a month. If those things are not helpful, then the next step would be colonoscopy. Colonoscopy is the best way to obtain samples for infection and biopsies for inflammatory changes. You must make sure, however, that your doctor is able and willing to do those tests during the procedure and has a camera to take some pictures of your colon.

Finally, things like smoking, alcohol and drugs hinder the ability of your body to set all things to rights.

Hello,

Welcome back to icliniq.com.

If you look at the requirements for sending in GI map samples, they allow up to six days from the time of sample collection to when it must be processed. I think that gap will be fine. They should give you instructions and a container. You do not want to scoop the stool out of the toilet. I do not think the time of day matters.