Possible HIV symptoms

[timmysp]

Hi,

First of all I want to applaud the service you provide. It helps so many people.

My sexual encounter involved the following (I am male):

- Unprotected oral sex with an Asian CSW. CSW work in a very low end brothel.
- I fingered the CSW. (Raw hang nail on insertive finger)
- Anal fingering by CSW on myself

The sexual encounter was 19 days ago and I have since developed the following symptoms
- Tender swollen lymph nodes in my neck (one node swollen after 7 days, 2nd node after 12 days)
- Dull pain in my testes (after 2 days)
- Headaches (after 7 days)
- Slight fever (after 7 days)
- Sore throat (after 7 days)
- Two large mouth ulcers on inside upper lip (after 14 days)

1) Could the above symptoms point to ARS or is it more than likely some less serious?
2) Is the above possibly just stress related?

I know people say not to judge by the symptoms but the above symptoms seem to tie in with ARS and as ARS normally shows up 2-4 weeks after infection i have become somewhat concerned.

I am uncircumcised and have tight foreskin which causes me to have tender cracks on my foreskin when my penis becomes erect.

3) Could these tender cracks be a point of transmission assuming that the CSW's mouth had sores or was bleeding?

Any advice on this would be greatly appreciated.

Thank you

[Edward W Hook, MD]

It is apparent that you have read our comments on this site in the past  That makes your concern surprising to me.  As we've pointed our numerous times in the past, the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes.  Thus despite the fact that some of your symptoms resemble some of the symptoms described for the ARS (and some do not), this does not change the fact that they are unlikely to be due to HIV.  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  Thus for you to try to judge their HIV risk based on "ARS symptoms" is a waste of time.  Your symptoms are almost certainly due to something else (stress included)

Regarding your circumcision status, being uncircumcised does increase a person's risk of acquiring HIV somewhat - about three-fold.  Once again, were talking averages.  the cracks you describe could be part of the reason for this increased risk among uncircumcised men.  As far as your situation is concerned, even if your partner was HIV infected, receipt of oral sex is very, very low risk.  Thus as an overall assessment of your risk, I judge it to be very, very low--close to zero.  

For the future however, condoms remain recommended - why press your luck at all.  Take care.  EWH

[timmysp]

Dr. Hook,

Many thanks for your comments.

It is interesting to hear that the average risk goes up three fold with uncircumcised men.

As HIV cannot be transmitted via saliva what oral hygiene deficiencies would the CSW have to have had for the virus to be transferred orally? Does it require bleeding from the mouth or an open sore?

I assume the cracks in my foreskin would not pose a risk for transmission if the CSW had no oral deficiencies. Is this assumption correct?

I guess the best way to be 100% sure I have not been infected is to be tested after 6 weeks and then again after 12. Is this recommended or is the risk factor so low that testing would not be warranted?

As for future, a condom will definitely be used! Perhaps two :-)

Thanks

[Edward W Hook, MD]

The figures I provided to you represent data from enourmous numbers of persons, some of who had any variety of deficiencies in their oral hygiene  The 1 in 10,000 figures holds for all  irrespective of whether the person performing oral sex had poor oral hygiene or not and irrespective of whether the recipient had penile cracks or not.

As far as testing is concerned, given the very low risk nature of your exposure, I think testing at 6 weeks would certainly suffice.  By that time over 95% of tests that are going to be positive will be.  At 12 weeks the last 5% would add little (in my opinion).  EWH

[timmysp]

Hi Dr.,

I assume that the 1 in 10,000 statistic is based on the partner been HIV positive. Is this correct?

Thanks

[Edward W Hook, MD]

Correct.  EWH

[timmysp]

One final question. Given the above sexual encounter would you recommend testing?

Thanks

[Edward W Hook, MD]

I've already answered this question.  See above.  EWH

[timmysp]

Hi Dr.

I recently got tested and am awaiting my results.

The test was 39 days after exposure.

1. Is there any difference in the percentage accuracy between getting testing at this time and between waiting until 42 days (6 weeks)?

2. Can the result still be considered 95% effective at 39 days?

Thanks

[Edward W Hook, MD]

A slight amount.  Your test will be negative and you do not need to worry after your test comes back negative.  It is time for this thread to end.  No further questions please.  EWH

[timmysp]

Thanks for your feedback Dr.

The test was negative like you suggested. My GP is recommending that I get tested again at 3 months and six months. I thought 3 months was definitive. Is this not the case? Is testing required at 6 months before the all clear is given?

This will be my last question and will close this thread should you decide to respond.

[Edward W Hook, MD]

No further testing is required.  Your GP is being more conservative than he/she needs to be.  EWH