Dear Dr. Handsfield,

I made a very big mistake while intoxicated, and had unprotected insertive vaginal sex with 2 different CSWs in Dubai.  

On the 9th night after the incident, while sleeping, I had some mild stomach pain which I attributed to dinner.  The next morning,  I had back pain in the mid/upper back region which started a few hours after I woke up.  My back felt stiff and hurt mainly when I moved and did not hurt when I was lying down.  I took some paracetamol but it did not help much.  I did measure my temperature and there was no fever (but it was after the paracetamol).  I had not done anything to aggravate my back and have never had pain like this before.  By the next morning, I would say it was 95% improved and otherwise feel fine.  I know the risk is high.  And the timeline for ARS is in the range.  My questions are:

1.    Is this back pain what medical professionals would refer to as myalgia or arthralgia which is a common symptom of ARS? 

2.    Is myalgia/arthralgia associated with ARS or viral infections like the flu characterized by stiffness and pain on movement or pain regardless of movement?

3.    Can one have viral related myalgia/arthralgia without fever?

4.    Can ARS present as back pain like this for 1-2 days without any other symptom like sore throat, fever, rash, etc.?  Or maybe the other symptoms were too mild for me to have noticed?

5.    I can’t take the test here in Dubai because it is reportable and they deport you if its positive.  So I plan to test in a different country in 10 days.   Would the Duo test be sufficient (it would be 20 days post exposure by then and 10 days post symptom onset) or should I do the RNA test?

Thanks for your insight

Welcome to the Forum.  Dr. Handsfield and I share the Forum and I will be answering your question today.  The encounters you describe were risky but not necessarily high risk.  Most CSWs in Dubai do not have HIV (or other STIs) and even when they do, most exposures (fewer than 1 in 1,000) result in infection.   Nonetheless, I understand your concerns.  As I'll explain below, the symptoms you describe do not suggest the ARS of recently acquired HIV.  Persons with the ARS have high fevers (admittedly yours may have been modified by your paracetamol), muscle aches (this may have been your back ache), and severe sore throat.   Typically these symptoms begin a1-3 weeks after an exposure and last for several days or a week. Even when persons have this "classical" collection  of ARS-type symptoms, fewer than 1% turn out to have HIV, the remainder having other far more common viral flu-like illnesses including influenza, COVID-19, and other viruses which are not typically tested for.  If your symptoms were due to HIV, an HIV blood tests would be positive at this time- symptoms are always accompanied by positive tests.  In answer to your specific questions:---

You ask questions about the ARS. The ARS is uncommon but well defined. The ARS is comprised of a severe sore throat, severe muscle aches, and high fevers, sometimes accompanied by diarrhea or a generalized skin rash. all occurring at the same time and last at least several days. The time sequence of your events really does not suggest the ARS following your relatively low risk exposure. If you feel that I am incorrect, you should test. As I said above, if you test your symptoms were due to the ARS your test would be positive.  I am confident they will not be. ---

As you know, we provide up to three responses to each client's questions.  This will be my 3rd and final response, following which the thread will be closed.  After that you should not need to return to the Forum.  Should you return with further repetitive, anxiety driven questions, your thread my be closed without a response and without return of your posting fee.  On to your follow-up questions:
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