Why did my friend and his family suffer from chronic weight loss after his unhealthy sexual exposure about seven years ago?

Hello doctor,

My friend is a 36-year-old male. His height is 5.5 feet weight is 123 lbs. He had some unhealthy sexual exposure seven years back. He said he got sick once and started losing weight beginning that time. In the last seven years, the average of 5 % every year, even though he is eating a lot to gain weight. He thought it was stress and ignored it. But his spouse also started losing weight like him, and then his kids did not gain weight and dropped in the percentile. All are eating a lot, but it is not helping. Their family from both sides have good weight and fat. So it does not look generic.

Last two years, he has been talking about slight joint pain, a crawling sensation in his feet, and feeling weak. He is also having locking or pinning pain while trying to squat. His five-year-old kid also has joint clicking sounds and weakness. So he was asked to consult an Infectious disease doctor himself first. So we are looking for your help.

Tests done:

He has recently checked for fourth-generation HIV 1 and 2, HSV 1 and 2, hepatitis A, B, and C, Chlamydia, Gonorrhea, Syphilis, CMV, EBV, urinalysis, and HTLV1. All tests came negative except HSV1 and EBV. He told me his annual check of complete blood count and comprehensive metabolic panel for the last three years looks normal. Upper endoscopy and colonoscopy is normal.

Please help with your input for all questions below, as it is critical for his whole family.

1. Is there any rare blood-borne parasite, bacteria, virus, or infectious disease test he is still missing?

2. Is it reactive or septic arthritis caused by bacteria or viruses?

3. Few tests like Mycoplasma genetalium, HPV, and Lymphogranuloma venereum have not been done so far. Any of this makes sense to get tested for his case now?

4. Will urine analysis or urine culture cover all sexual exposure bacteria?

5. Any infection that could be silently causing pancreatitis, liver, or thyroid damage for him?

6. In the last two years, his TSH went up, signaling hypothyroidism which could have caused weight gain. But for him, it is still weight loss. Any infection that could damage the thyroid and cause hyperthyroid followed by hypothyroid?

7. Is there any advanced diagnosis for rare cases when the basic STD panel does not find and still looks like some infection? If so, what are those?

8. Malabsorption or too much calorie burning is triggered by infection, I guess. Any other chronic or persistent infection you think could spread through blood and cause that?

Hi doctor,

Thank you for the reply.

He mentioned he had done all these tests mentioned at some point in the last three years. All those results are good. His whole family started losing weight one by one even though they ate more protein and carbohydrates to gain weight.

1. You mentioned chronic EBV impacting weight. Will that cause weight gain or weight loss? Since he is losing weight, he wants to confirm.

2. Are you an infectious disease specialist?

3. You mentioned parasites, can they be sexually transmitted and stay for this many years?

4. Is there any rare blood-borne parasite, bacteria or virus, or infectious disease test he still misses?

5. Is it reactive or septic arthritis caused by bacteria or viruses?

6. A few tests like Mycoplasma genitalium, HPV, and Lymphogranuloma venereum he has not done so far. Any of this makes sense to get tested for his case now?

7. Will urinalysis or urine culture cover all sexual exposure bacteria? Any infection that could be silently causing pancreatitis or liver or thyroid damage for him?

8. Last two years, his TSH went up, signaling hypothyroid, which could cause weight gain. But for him still weight loss. Any infection that could damage the thyroid and cause hyperthyroid followed by hypothyroid.

9. Is there any advanced diagnosis for rare cases when the basic std panel does not find, and still it looks like some infection? If so, what are those?

10. I guess that malabsorption or too much calorie burning is triggered by infection. Any other chronic or persistent infection you think could spread through blood and cause that?