[Question #10527] Receipt of Oral sex and ARS symptoms

22 months ago

I am a male (41 years) , on 22/9/2023, I had an encounter with a female sex worker in the middle east, unprotected blow job with no visible blood on my penis and protected vaginal sex where the condom remained intact till the end. On 03/10/2023, I start having very mild stuffy nose ( for 1 day) , mild sore throat , moderate Joint & muscle pain, unwell, no appetite, severe insomnia, other symptoms followed and persisting till date: depression, confusion, mild night sweats on and off , feeling hot even the weather now is cold, fast heart beats, lost weight even i am forcing my self to eat , trouble sleeping, no libido and ED.

22 months ago

On 12/10/2023, Negative HIV1/2 Ag/Ab Combo (5th generation).1)How much my symptoms are suggestive for ARS?2) I know there have been no proven cases of HIV transmission from mouth to penis, could you please tell me when the test (HIV Ab/Ag) shall turn positive in case of symptoms are related to ARS?

Edward W. Hook M.D.

22 months ago

Welcome to our Forum. Thanks for your questions. I'll be glad to comment. Congratulations on your use of a condom for genital contact- it will do much to prevent HIV and other STIs.

1)How much my symptoms are suggestive for ARS?

Your symptoms sound mild or perhaps moderate. Persons with the ARS typically experience severe sore throat, severe muscle and/or joint aches and high fever when they experience the ARS. I suspect some persons with the syndrome may have milder symptoms but your negative tests prove that your symptoms were not due to the ARS. When persons have the ARS tests for HIV are typically positive because the ARS is caused by the interaction of the HIV virus with antibodies produced in response to infection.

2) I know there have been no proven cases of HIV transmission from mouth to penis, could you please tell me when the test (HIV Ab/Ag) shall turn positive in case of symptoms are related to ARS?

See my comment above. Certainly tests for HIV would have been positive is your symptoms were due to HIV. Typically the test is positive at the time symptoms occur or certainly within a day of their onset. Your symptoms were most probably due to one of the other many viruses which most people acquire from time to time, i.e. influenza, COVID-19, or other community acquired viral infections. EWH

---

22 months ago

Thanks Dr. for your reply: same day of the negative HIV combo they tested me for ( HBV, HCV, CMV, TOXO) all showing old infections , Swap for COVID-19 negative, CRP 5.6 (limit=5). I had NO fever, No rash, No lymphadenopathy, No mouth sores. In 11/10/2023 i was in emergency department where they notice tachycardia and elevated blood pressure, they gave Norvasc 5 mg and referred me to the infectious department the next day, since i told them my story. Doctor what really concerns me is the set of symptoms that i never experienced before ( tachycardia, no libido, night sweats ) which is when i read is related to HIV.

1- Given the negative HIV combo test after almost 8-9 days of the onset of the first symptom, can i exclude that those symptoms are related to HIV? 2- can i resume unprotected sex with my partner ( if libido is back) or further testing is warranted given the symptoms.3- from your experience what can cause such symptoms? 4- can heart problem and no libido at all ( no erection in the morning), severe insomnia, comes so early in HIV infection? Thanks for your patience.

Edward W. Hook M.D.

22 months ago

Thanks for the additional information. In response to your follow-up questions"

1- Given the negative HIV combo test after almost 8-9 days of the onset of the first symptom, can i exclude that those symptoms are related to HIV?

Yes, absolutely.

2- can i resume unprotected sex with my partner ( if libido is back) or further testing is warranted given the symptoms.

Yes

3- from your experience what can cause such symptoms?

There are many other viruses which might cause these symptoms. You were tested for the viruses the are treatable and might cause your symptoms but there are many, many other viruses which could also have caused your symptoms.

4- can heart problem and no libido at all ( no erection in the morning), severe insomnia, comes so early in HIV infection?

These are not signs of recently acquired HIV. Anxiety could certainly be a contributor

EWH

---

22 months ago

Dear doctor, when I did The combo test, I insisted to see the doctor and he said that usually they make both Elisa 4ht gen & western blot in parallel !!!!??? and in my case both were negative. Sure I did not believe him, for me that means that the first test was doubt or positive and they run the westernblot which is less sensitive and look only for antibodies. Disregarding the advantage

22 months ago

Of the 4th generation test, my question, since I am still loosing weight (5kg)and not feeling well, it can be that some lab do both Elisa & westernblot in parallel any way? Any way today i went to the STI department and I explained my case, they said I had virtually zero risk and I am overthinking however they will do another combo test at 30 days mark, doctor I am in nightmare, due to : Symptoms, unbiguos test and doctor reply, my only hope right now is your assessment for the risk of received oral sex? And if the antibodies' parts of the test shall be positive after 8 days of the onset of symptoms or only the p24 which appear they missed by doing the immunoblot? Your help much appreciated to survive untill n'est week

Edward W. Hook M.D.

22 months ago

I cannot comment on your doctor's decision to perform both a 4th generation ELISA test and a Western blot- that is his decision. I also cannot imagine why he would lie to you however. I once again encourage you to believe your test results.

Regarding your continued weight loss- this is a non-specific symptom and in fact is NOT characteristic of recently acquired HIV.

You have been told by me and other doctors you have seen you are not at risk. You are having trouble moving forward however. My sense is that you are over reacting and anxious or perhaps feeling guilty about you exposure. You need to move on.

Finally, in response to you question about the presence of HIV antibodies at the time symptoms are present, I will suggest you re-read my original reply in which part of what I said was "... the ARS is caused by the interaction of the HIV virus with antibodies produced in response to infection."

As you know, we provide up to three responses to each client's question. You are worrying needlessly and need to believe your doctors and move forward. This will complete this thread and there should be no need for you to return to the Forum. If you return with additional repetitive, anxiety-driven questions, you question may be closed without a response and without refund of your posting fee. EWH

---