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

Answered by
Dr. Nancy Lynn Wespetal
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 07, 2020

Hello doctor,

I am suffering a serious problem after unprotected sex with an unwknown woman on March 2018. After 21 days of sexual exposure, I suffer superficial gastritis (according to endoscopy). I have oral candidiasis, fatigue all the time. Several times I met the doctor and he prescribed antibiotics. It does not help. I need to go toilet four to six times a day and suffering diarrhea and indigestion till now.

After five months, CBC show 74% neutrophil and 14% lymphocytes, normal ESR but now CBC report is normal. HIV test reports always come back negative until 1year and 6 months. HIV fourth generation, HIV rapid, Elisa and RNA PCR did not detect HIV after one year.

Stool shows mucus but others are normal. Urine is also normal and negative for other sexual infections after seven months. After a year, CD4 705 and CD8 500 and its ratio is 1.4 (normal). It is not my mental stress, but I have indigestion for the past two years. Please help me to find out the reason for gastritis and diarrhea.



Welcome to

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.

Thank you doctor,

I want to inform you I never had those problem before that unprotected sex on March 2018. I strongly believe it is not lifestyle causing my symptoms. I met with a gastrologist, but she does not understand my problem. My stomach cannot digest food, need to go toilet three to five times a day with watery diarrhea most of the time.

After that exposure I am suffering the following symptoms.

I lost 10 kg during the first three months, but after that I gain it again, now my weight is normal.

Antibiotics are totally not effective for me, I feel as usual like past after taking antibiotics.

I had body rashes and extremely fatigue. I am not able to work until 5 months, but now I can work but suffering from gastritis and diarrhea as usual.

Yes, I had done stool culture test twice, last month it show normal but it indicates greenish brown colour stool, mucus, fat globulin, and vegetable cell.

Yesterday, I found red colour stool and I think it is blood but before I did not suffer it. Stool cultural test did not find blood (1 month ago).

I did endoscopy two years ago and find acute superficial gastritis. No ulcer was found but lab technician told my stomach look red color. I did not do colonoscopy yet. I am a student and unmarried. I take rice, meat, chicken, vegetables, and fruits. I take small meal and avoid spice. I strongly believe my symptoms are not for my food habit. I have never had fever. No smoking, no drugs, or no vodka.

Another sexual transmitted infection like HIV, hepatitis B andC, Helicobacter pylori all negative, only cytomegalovirus IgG positive IgM negative. It shows infection in the past. I have oral candidasis, I notice it when I start suffering with gastritis, still I have these. Please help me to find out the cause and you can suggest more tests if needed (like intestinal or stool infection). Should I test for stomach parasite like comprehensive stool analysis test?



Welcome back to

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?

Thank you doctor,

Actually it is not the reason of my mental stress or anxiety. Because when I pass happy time with my family also I suffer the same symptoms. Diet is also not the fact, and I take food as usual. I do not think antibiotics use is causing this, because I suffer the symptoms first, and later took antibiotics. When it did not help me, I avoided it.

But yes, infection is the one that really matches my situation. But it is important to find out which type of infection. If stool test for ova and parasites are helpful, I must do it. But can parasites transmit by unprotected sex or oral contact? My friend told me GI map test is more sensitive to rule out the cause of infectious diarrhea. Is that true and do you think I should try for this test?



Welcome back to

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.

Thank you doctor,

Actually, I found on the internet that gastritis and diarrhea are different matters. But it is happening together with me. My endoscopy shows acute superficial gastiritis. Do you think gastritis can be the cause of diarrhea as well as indigestion? Beside this I have oral candidiasis (oral thrush) with white tongue since that exposure. It is the most common symptom of HIV, but rarely it can indicate other sickness as well. Can this fungal/candida affect GI track and which test is helpful to detect it?

Now when I see red color stool, I heard that it happen with ulcer and stomach cancer like more serious conditions, is not it? Because I am suffering these for two years. Is my HIV test conclusive after two years negative? I think colonoscopy normally shows the conditions of colon but can colonoscopy and biopsy help to diagnosis infectious gastritis too?



Welcome back to

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.

Thank you doctor,

I have taken Fluconazole 100 mg twice a day for 15 days over and oral cream also according to physician here. Those are very effective for me but not 100%, because I had a lot of candidiasis on tongue. Should I continue it more? I told you my complete blood count showed higher 74% neutrophil and 14% lymphocyte, ESR was normal, others were also normal, but doctor told it indicates an infection but can you understand which type of infection it might be, bacterial or viral or parasite? Again after two months my complete blood report show normal. Yes, it is my stool test report but the name is not there because of my social privacy, please check and comment about it.



Welcome back to

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.

Thank you doctor,

How to collect the stool sample properly? I saw in the website that morning stool is better for test and sample should reach to lab within two hours of collection. But in my country lab collect the sample at morning and send it for diagnosis at afternoon, even sometime they send stool sample to another nearest country for more sensitive/expensive test. All the process may need one to three days. Will it able to show accurate results?



Welcome back to

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.

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