Low Lymphocyte Count: Could It Indicate HIV Infection? - Internal Medicine

A low lymphocyte count and a neutrophil count near the upper limit of normal could potentially indicate various conditions, including HIV. However, these findings alone are not definitive for an HIV diagnosis. It is important to consult a healthcare professional for further evaluation and testing?

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Hello, doctor.
My story might be a bit long, but due to my symptoms, concerns, and test results, I have been unable to find answers, so I sincerely ask for your assistance.
I have no history of risky or unclean behavior, but I did visit a hot spring a week before the onset of my symptoms.
However, everyone says the chances of getting sick from that are low.
In mid-December last year, I noticed pain during urination and had purulent discharge, so I immediately sought medical attention at a clinic.
However, there was no discharge during the examination.
The doctor asked me to pay out of pocket for tests for gonorrhea, chlamydia, trichomoniasis, and a urinalysis.
That day, the doctor administered an injection and prescribed antibiotics (Doxycycline).
A few hours after returning home, the pain during urination ceased, and there was no more discharge.
A week later, all test results were normal, but I still occasionally felt urethral pain and glans discomfort (not during urination), which usually lasted only a few seconds and did not occur every day.
Sometimes I felt as if there was something in my urethra, and the urethral opening appeared slightly reddened (though all the doctors I consulted said it looked fine, I am certain it wasn't this red before I got sick).
After that, the doctor prescribed a second-line antibiotic (Azithromycin 250mg), which I took four pills of in one day, but there was no improvement.
After taking antibiotics for over two weeks without any progress, I suspected that I might have had sexual contact with my wife (unbeknownst to me at the time of onset), so I asked her to get checked at an obstetrics and gynecology clinic, and her results were normal.
I then switched to a larger regional hospital, where my urinalysis results were consistently normal (at least five times).
The doctor also tested me for HIV and syphilis (about four weeks after suspected exposure), and both results were negative.
However, my symptoms persisted, and the doctor did not believe it was caused by bacteria.
For nearly a month afterward, I took anti-inflammatory pain relievers (Diclofenac 25mg) and Pyridium (100mg), but my condition fluctuated.
I then decided to go to a health check center and a medical laboratory for a comprehensive examination.
In early February, I underwent tests at the health check center and medical laboratory (about eight weeks after suspected exposure).
A few days later, the medical laboratory report showed negative results for gonorrhea, HIV I/II ELISA, syphilis, HPV, herpes, and hepatitis types A, B, and C, but it did indicate the presence of staphylococcus and ureaplasma, as well as nitrite.
The medical technician informed me that these could be treated with medication.
I took the report back to the regional hospital, but the doctor said the PCR testing method might be too sensitive and that I might not actually have those infections.
Nevertheless, he prescribed two antibiotics: Vibramycin 100mg (Doxycycline) and Cephradine 500mg (Lisacef) for seven days.
A few days later, I felt some relief, but on the fourth day of treatment, after having protected intercourse with my wife, the pain returned on the sixth day.
Of course, I couldn't be sure if it was due to the sexual activity, but since becoming ill over the past two months, I had only engaged in protected intercourse with my wife twice.
During my follow-up visit in the second week, the doctor noted that my symptoms had not improved, so he prescribed another week of the same two antibiotics (I have been taking them for about 11 days now).
Yesterday, I went to a large teaching hospital to see a urologist, who said it might be difficult to cure (heartbreaking).
He only tested my urine and prescribed a week’s supply of a second-line antibiotic (Azithromycin 250mg) to be taken once daily.
When I received the medication, I realized I had already taken this drug previously without significant effect.
Now, I am struggling to decide which medication to take.
The health check center's report indicated slightly elevated cholesterol and total bilirubin (I have Gilbert's syndrome), which are old issues that do not particularly worry me.
However, I am concerned that although my white blood cell count is normal at 4.97 (reference range: 3.54–9.06 K/uL), the differential count shows that my lymphocyte percentage dropped from 45.4 last year to 20.9 this year (reference range: 21.2–51%).
My neutrophil percentage increased from 46.6 last year to 74.3 this year (reference range: 41.2–74.7%).
My monocyte count decreased from 4.9 last year to 4.0 this year (reference range: 3.1–8.0%), while my eosinophil count dropped from 2.5 last year to 0.4 this year (reference range: 0.2–8.4%).
My basophil count decreased from 0.6 last year to 0.4 this year (reference range: 0.2–8.4%).
My lymphocyte count has dropped over 20 percentage points compared to last year and is now below the normal range by 0.3%.
My neutrophil count has risen to the high end and is nearing the reference range limit.
My eosinophil count has decreased by 2.1% and is close to falling below the reference range.
The basophil count, while not significantly different, has been consistently at the lower limit and is decreasing.
Two weeks ago, I started developing small fatty lumps on my forehead.
Initially, I thought it was due to the cold, dry weather.
They are not painful or itchy, but they have been increasing in number, even appearing near my temples and behind my ears.
I consulted a dermatologist, who suggested it might be due to oily skin, but some have turned brown, and some have mild pain, resembling small papules.
These symptoms and test results have left me exhausted, and the old symptoms have not improved, while other worries have compounded over the past three months without any reassurance.
The story is long, but I just want to ensure nothing is overlooked.
I have only a few questions for you, doctor:
1.
Although every medication can have side effects, and some warnings mention skin rashes, could the rash on my forehead be caused by long-term medication use?
2.
I had HIV and syphilis screening at a regional hospital four weeks after suspected exposure (not sure what type of tests were done) which were negative.
Eight weeks later, I had an HIV I/II ELISA fourth-generation test, syphilis, and other tests at a medical laboratory, all of which were negative.
I know it’s best to test again after 12 weeks; is there a chance of a different result after 12 weeks?
3.
If I test again after three months (12 weeks) and the result is negative, can I feel reassured?
4.
My lymphocyte count has decreased and is below the standard value, and other white blood cell differential counts seem worse than last year.
Could the decrease in lymphocytes and these values be related to long-term antibiotic and anti-inflammatory medication use?
Thank you very much for your valuable time, doctor.
I apologize for the length of this message, but my family and I are really at our limit.
I hope you can assist me.
Thank you!

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Wang Ping'an, 30~39 year old female. Ask Date: 2017/02/24