[Question #10865] HIV Risk

19 months ago

Hi Dr,

I'm a male 32 years living in dubai. I had 2 recent encounters that i'm extremely worried about.

The first encounter was on December 8th with a russian CSW where I had protected vaginal intercourse with her. i was drunk but i'm confident about wearing the condom from start to finish. she even asked me to wear the condom before we started.(This is the ecounter i'm most worried about)

my second encounter was on January 2nd with a girl in Egypt she is friend of friends. we had a protected vaginal intercourse and unprotected blow job but she doesnt seem to sleep around alot with different people.

My anxiety started 2 weeks ago and has risen exponentially since 3 days ago as i started developing symptoms (38 days post 1st encounter and 13 days post 2nd encounter). synptoms are as follows.

Jan 15th --> pain in my mid center back that comes and goes

Jan 16th --> 1 miunte of muscle twitching right above my right knee + feeling of tingling/numbness in both of my legs (starting my toe till my knee.

Jan 17th --> Tingling/numbess feeling in my right leg continues but comes and goes.

I visited an orthopedic today and he suggested that i might have peripheral neuropathy which frustrated me as i know that PN might be a symptom of ARS. I have read at national institute of health NCBI, that the average time to get PN has a median of 3.5 months after your HIV transmission. I will go tomorrow to do a nerves test (EMG i believe) to confirm the cause.

Please help me with the below questions I'm extremely frustrated and couldnt live my life normally. I haven't tested until now as im scared of the results.

1- what's your overall evaluation of my risk for HIV ?

2- Is testing necessary in my case given the risk of both encounters ?

3- if peripheral neuropathy is confirmed tomorrow what would be your evaluation ?

Thank you.

Edward W. Hook M.D.

19 months ago

Welcome to our Forum. Thaks for your questions. I'll be glad to comment. You are fortunate to live in a part of the world where HIV (as well as other STIs) are rare, even among commercial sex workers. Further, the encounters you describe were virtually no risk- you used a condom for both encounters and condoms are highly effective, HIV has never been acquired from receipt of oral sex and the fact that your first partner suggested using a condom is evidence that she is not infected- after all, CSWs use condoms primarily to protect themselves, not their clients.

In addition, your peripheral neuropathy symptoms are quite non-specific and PN is a very rare symptoms of the ARS.

Regarding your specific questions:

1- what's your overall evaluation of my risk for HIV ?

See above, I would have no concerns about HIV.

2- Is testing necessary in my case given the risk of both encounters ?

I would not bother to test. If you chose to test, any test at all will now provide conclusive results as to whether or not you were infected at your Dec 8 encounter. Testing with and HIV RNA PCR test would provide reliable, conclusive results for both encounters.

3- if peripheral neuropathy is confirmed tomorrow what would be your evaluation ?

As I said above, PN is rare from recently acquired HIV. I would not be worried at all and would seek other, non-STI causes.

I hope this information is helpful. EWH

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19 months ago

Hi Dr. Edward,

Thank you for your response.

The reason im frustrated is that i have never had any symptoms before for PN and the timing is very frustrating. I have a couple more questions please.

Let's imagine i didnt have the second encounter and my only encounter was the one on December 8th which means that the PN appeared 38 days post encounter. 1- Does this timing match the timing of usual ARS symptoms ?

2 - Have you seen before anyone with PN as a symptom of ARS ?

3- Can PN be a symptom of ARS if it came only with diarrhea and without fever or sore throat ?

4- I know that i wouldnt be able to move on without testing and that i will do it sooner than later to calm down if the results

are negative but if I was your patient would you advise me to test given the encounters or you would tell me to move on without testing ?

5- will you think my infection risk rate is less than 1 in a 1000 if i found out i have PN ?

Thanks again for all your efforts, i hope that one day i will test and find out that im not infected with HIV.

Edward W. Hook M.D.

19 months ago

Your symptoms may well be coincidental. Regarding your follow-up questions:

1. No, in fact ARS symptoms almost always occur before 30 days have passed. This is too late for the ARS related to your 1rst encounter

2. Never seen, nor heard of this manifestation of ARS

3. No

4. If you test at this time, the results will tell you whether or not your PN is a manifestation of the ARS. When persons are experiencing ARS symptoms, tests are always positive

5. Your suggested risk is far too high. At most your risk is 1 in 100,00 and probably closer to 1 in a million

I am confident your PN is not sue to HIV. EWH

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19 months ago

Hi Dr.

Many thanks for your reply, Yesterday i have taken a leap of faith and tested in dubai all came back -ve including (HiV Combi(I&II Antibodies +P24 Antigen), Hep.B, Hep.C, HSV I, HSV II, Chlamydia, Gonorrhea). However my symptoms are still there Muscle ache in my back and forearm(new Symptom) as well as diarrhea and head feeling hot.

1- Last year i took the same HIV test and it was -ve with a value of 0.16, This time the result came -ve with a value of 0.22. Does this have any meaning ? given that the reference in the test says Less than 1.0 is non reactive.

2- The test is done 42 days post my 1st encounter , i would assume that by any means it makes no difference from testing at 45 days right ?

3- my urine test indicates that protein is 1+ does this have any relation with any STDs ?

4- My biggest worry was from the 1st encounter as she was CSW. However i started worrying as well from the 2nd encounter as the symptoms time matched the ARS timing of the 2nd encounter. (symptoms started 15th Jan and i tested 20th of Jan) my question is if my symptoms were due to HIV from 2nd encounter the tests would have caught it and be +ve or it wasn't enough time to show on the test ?

5-My tests were done only 18 days post 2nd encounter does this mean that they have abolutely no value for my second encounter?

6- would you advise me to test again for the 2nd encounter (she isn't a CSW, lives in Egypt, i tend to believe she doesn't have alot of sexual partners)

7- is it safe now to have sex with my girlfriend without protection?

Lastly i would like to thank you again for your efforts.

Edward W. Hook M.D.

19 months ago

'm glad that you tested and have proved to yourself that you were not infected. It is now time to put your concerns behind you and move forward. I'll answer your follow-up questions briefly:

Fluctuations of this sort are entirely normal. Negative is negative. That your value is slightly higher is irrelevant. Have confidence in your negative result

2- The test is done 42 days post my 1st encounter , i would assume that by any means it makes no difference from testing at 45 days right ?

The results are conclusive and will not change. There is no need to test again.

3- my urine test indicates that protein is 1+ does this have any relation with any STDs ?

No, this can be an entirely normal results

Correct. When symptoms are due to HIV, tests are always positive

5-My tests were done only 18 days post 2nd encounter does this mean that they have abolutely no value for my second encounter?

A test at 18 days proves that your symptoms are not due to HIV. Not everyone who gets HIV has symptoms and results are not entirely conclusive until 42-45 days. In your case however, your exposures were no risk. I encourage you to move forward without concern.

6- would you advise me to test again for the 2nd encounter (she isn't a CSW, lives in Egypt, i tend to believe she doesn't have alot of sexual partners)

I see no need for further testing

7- is it safe now to have sex with my girlfriend without protection?

Yes.

This completes this thread which will be closed shortly. Take care. Please

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18 months ago

Hi Dr,

Im back with a final question please as im extremely worried.

Almost 2/3 week go i had unprotected sex with my girlfriend. The problem is yesterday she developed a muscle ache in her lower right back and leg. Today she is having a skin rash on her inner thigh which is like a red blotch. When she showered in the morning it was bumpy but now its just very red. Im extremely worried that i have transferred to her hiv or any other disease.

Could this muscles ache and rash be due to Ars as it matches the timing of the Ars. She doesnt have fever or sore throat until now.

I wouldnt have returned to the forum if it wasnt for theses symptoms. Its very weird that she develops a rash now !!

Edward W. Hook M.D.

18 months ago

This thread should have been closed previously. It will be following this response

You have proven you do not have HIV. Your partner's rash and muscle ache are not suggestive of the ARS.

You are worrying needlessly. EWH

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