Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins / codeine attending: chief complaint: viral syndrome nos major surgical or invasive procedure: lumbar puncture history of present illness: 50-year-old gentleman with hiv since (last cd4 463, vl <50 ), who recently stopped his arvs about 1 week ago. presented to clinic with complaints of 3 days of fevers to 103-104, chills, sore throat, myalgias, and ha, intermittent rlq pain, photophobia, and neck stiffness. . he says he began to feel ill which started with fevers and chills 3 days prior to presentation (early saturday morning). he also reports ha that was diffuse and that responded to tylenol, although he says the fevers did not. he also reports mylagias, sore throat, nausea, no emesis or diarrhea. has not been eating much over the weekend, but has tried to drink fluids. no sick contacts. travel. per clinic notes, says that this feels "just like i did when i converted." . he does report unprotected receptive and insertive anal sex over the past few weeks with a partner of unknown status. one episode 3 days ago of dysuria. . initial vs in the ed: 102.2, hr 72, bp 106/67, rr16, 02 sat 97. given decadron, ctx, vanco, acyclovir and motrin. past medical history: 1. hiv (per clinic notes) diagnosed with hiv in , risk factor being msm. on diagnosis, his initial cd4 count was 300 and his viral load was >100,000. by record, his known cd4 nadir was 60 from his initial years in care in . he started haart in with epivir, sustiva, and d4t. he was on that regimen for about 60 days and had ?lactic acidosis so his epivir was switched videx at that time. he discontinued all medications in and moved to . he had been off medications until when he started the regimen of truvada and kaletra which he has been on since that time. (of note, his viral load was 3,160,000 on , when he started haart.) good response to that regimen with viral load becoming undetectable by . 2. rheumatic fever as a child. 3. h/o non-cardiac chest pain (negative cath in ) 4. major depressive disorder (hospitalized at hospital in ) 5. chronic renal insufficiency (baseline 1.4-1.6) 6. chronic elevation in cpk. 7. h/o genital herpes social history: works as a social worker, tobacco, etoh, or iv drug use. rare marijuana. family history: nc physical exam: pe 101.6 108/68 60 93ra gen: laying in bed, non-toxic, but uncomfortable appearing heent: mmm neck: supple but pain with neck movement jvd flat, no carotid bruits chest: ctab, no wheezes, rales or rhonci cvs: rrr, no m/r/g abd: soft, nabs, nd, no rebound. mild vol gaurding and mild rlq tenderness to palpation extrem: no c/c/e neuro: cn ii-xii intact, no kernigs or brudzinskis msk: no joint effusions, normal rom pertinent results: ehrlichia/babesia ab: p 09:25am hcv ab-negative 09:25am hbsag-negative hbsab-positive hbcab-positive 09:25am alt-81* ast-57* alkphos-118* totbili-0.3 06:15am alt-74* ast-76* alkphos-76 totbili-0.3 06:15am glucose-95 urean-10 creat-1.6* na-136 k-4.1 cl-103 hco3-27 angap-10 09:25am wbc-6.8 lymph-25 abs -1700 cd3%-60 abs cd3-1027 cd4%-19 abs cd4-330* cd8%-38 abs cd8-642 cd4/cd8-0.5* 07:25am parst s-negative 09:25am wbc-6.8 rbc-4.62 hgb-15.0 hct-44.5 mcv-96 mch-32.5* mchc-33.7 rdw-12.5 plt ct-309 06:15am wbc-2.6* rbc-3.96* hgb-13.2* hct-37.6* mcv-95 mch-33.3* mchc-35.0 rdw-11.8 plt ct-183 11:30am cerebrospinal fluid (csf) wbc-2 rbc-0 polys-0 lymphs-75 monos-25 11:30am cerebrospinal fluid (csf) totprot-25 glucose-66 . micro crypto ag negative (/csf) rpr: positive hiv vl: greater than 100,000 copies/ml urine gc/ct: negative hbv vl pending . ct abd/pelvis: unremarkable ct of the abdomen and pelvis. . ct head w and w/o: no acute intracranial hemorrhage or enhancing mass. please note most often ct is normal in meningitis. . pcxr: no acute cardiopulmonary process. . brief hospital course: #+rpr: felt to be primary syphillis given lack of rash and recent gential lesions; lp bland making tertiary syphillis unlikely. intially started on doxycycline given pcn allergy; however, id eventually recommended pcn desensitization. transferred to the icu, where he underwent desensitization. after the desensitization he was treated an infection of 2.4 mu im pcn. this will be followed immediately by pcn vk 250 mg po qid x2 weeks with weakly pcn shots for 3 shots total. #febrile syndrome nos: no evidence of meningitis or other intraabdominal process. csf, urine and cutlures pending. likely rebound syndrome from withdrawl of haart (retroviral rebound sydrome) vs spirochetemia vs infection with new hiv strain as hiv vl was >100,000. however, given pulse/temp disconnect, ehrlichia and babesia were sent and was (penidng at time of d/c). . #unprotected sexual encounter: rpr and hiv results as above; hep c ab negative. hepatits b panel with evidence of prior infection; hep b vl pending. . #elevated lfts: hep b/c as above; ?secondary to hiv viremia of syphillis. lfts stable during hospital course. . #hiv: per id, holding haart initally held until cr improves . #arf: cr above baseline, likely secondary to dehydration. was given aggressive ivf and recheck in am . #post lp headache: pt developed worsening positional ha after lp. given caffeine, hydration, and morphine tried with limited success. seen by chronic pain service who recommended pca for pain control. felt that a patch was too risky of leading to epidural abscess. headache subsequently improved. . #leukopenia: during the hospitalization developed mild leukopenia (6.8-->2.6), felt to be likely secondary to hiv viremia. medications on admission: kaletra, truvada (recently discontinued) wellbutrin sr 150 androgel ativan trazodone 50 qhs prn discharge medications: 1. penicillin v potassium 250 mg tablet sig: one (1) tablet po q6h (every 6 hours) for 2 weeks. disp:*56 tablet(s)* refills:*0* 2. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). disp:*60 tablet sustained release(s)* refills:*0* 3. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 4. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours): take until 3 days after rash resolves. . disp:*30 capsule(s)* refills:*2* 5. truvada 200-300 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 6. kaletra 200-50 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 7. hydromorphone 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain for 3 days. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: syphilis hiv post-lp headache discharge condition: stable discharge instructions: during this hospiltalization you were diagnosed with syphillis as well as possible rebound syndrome from stopping your hiv meds. you were desensitized to penicillin and treated with acyclovir for possible herpes infection. please restart your truvada and kaletra. it is extremely important that you take your penicillin every six hours - if you miss a dose you could be at risk for having an allergic reaction again. it is also imperative that you attend your nurse appointments and your appointment with dr. . please resume your hiv medications. followup instructions: 1. provider: ,peck psychiatry hmfp phone: date/time: 2:00pm 2. provider: , call to schedule appointment. 3. please follow up with id nurse at 9am and on at 9am for your penacillin shot in the basement of the . provider: , rn phone: date/time: 9:00 provider: , rn phone: date/time: 9:00 4. provider: . phone: date/time: 10:00am procedure: spinal tap incision of lung immunization for allergy diagnoses: acute kidney failure, unspecified human immunodeficiency virus [hiv] disease chronic kidney disease, unspecified dehydration reaction to spinal or lumbar puncture aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other primary syphilis 

Answer: The patient is high likely exposed to