Hi, 

First of all, I'm from Brazil so, first and foremost expect some bad written English.

On April-06 I possibly had a HIV risk exposure with a CSW at a high-end Massage Parlor here in my city.

I was drunk and don't remember quite well If i used a condom.

I might have used but I'm writing this out of fear for not having done so.

There was french kissing, foot worship and vaginal sex.

On April-20 i started having a mild flu with no fever nor severe sore throat symptoms.

On April-22 i did a quick finger prick test and tested negative to HIV, I do know due to the window period it's inconclusive though.

Then, the mild flu was over.

On May-03 i had a rash in my left upper arm that lasted for 3 days only, once again no fever and sore throat were present.

Also, In these past few days (over 30 days from exposure) I've also been having some nausea and sometimes I feel like my lips are burning.

a) Can those symtoms above be a sign of ARS?

b) In the event I didn't use a condom, it's also worth noting that I've got balanitis, does this increase the risk of getting HIV? If so, how much? 

The symptoms of acute retroviral syndrome (ARS, i.e. initial HIV infection) are not caused by the virus but by the immune response, which is indicated by antibody. If someone tests negative for HIV antibody, it proves that any symptoms present are not due to HIV/ARS. In other words, your April 22 negative finger stick test proves your symptoms starting April 20 were not from HIV. A localized rash on an arm and your mild nausea and burning lips do not suggest HIV; and as I think you already know, absence of fever and sore throat also make ARS less likely.

Equally important, the likelihood a "high end" partner in Brazil has HIV is very low; and even without a condom, if a female partner is infected, the average risk to her male partner is only once in every 2,500 vaginal sex exposures. And the virus has never been documented to be transmitted oral to penis. I suppose balanitis might raise the risk, but probably not very much.

For reassurance, have a lab based antigen-antibody (AgAb, 4th generation) HIV blood test 6 weeks after the exposure. Based on all you say, you can expect another negative result.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

It was a really reassuring answer.

I'm indeed getting text next week.

Just one question remaining, out of curiosity:

How bad is sore throat in ARS? Is it always severe? 

By this time (over 5 weeks from exposure) if something in my throat does come up can I rule that out as being a symptom of Acute HIV infection?

Can sore throat be the only symptom of ARS? Or is it always accompanied by fever and other symptoms?

Symptoms rarely are useful in judging possible ARS, despite lots of online advice about it. Half of all people with new HIV infections have no symptoms, and even with typical ARS symptoms, almost always HIV isn't the cause. Ignore symptoms and rely only on testing if potentially exposed or otherwise concerned about HIV.