[Question #12249] Unprotected Vaginal and symptoms 8/9 afterwards

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9 months ago
I am currently based in Canada, had an ONS with a 22 yo white Canadian girl I met on Tinder. on October 28th night. The intercourse happened around 1:30 AM, meaning we can say it happened on the 29th. We started kissing, she gave me a blowjob, and I tried penetration multiple times (the head of my penis slightly entered her vagina a bunch of times with brief (2-3 seconds) exposure each time. However, I penetrated her one time with full entry, which lasted 2-3 seconds before I pulled out. To sum it up, I managed full "thrust" one time and a handful of brief tries for penetration. There was masturbation between trying without lube because I couldn't hold an erection so there may be some micro tears on my penis. We stopped and she found an excuse to leave, couldn't get a hold of her afterwards. She didn't answer my texts
.On November 6th, which is 8/9 days after the exposure, I started feeling a little bit of a sore throat on one side (right) of my tonsils. didn't think much of it and got some ibuprofen for it. It ramped up on Friday with low grade fevers (37.2 37.6 Celsius), and my right tonsillar lymph node started hurting. Over the weekend, tonsil pain briefly shifted from right to left, and it subsided with lymph node pain taking over the scene. by Monday, tonsil pain had almost completely gone away, but the lymph node pain shifted to the left. 16 days after the incident, left lymph node pain became very apparent and resulted in neck mobility restriction. The fever shot up to a low 38, with 38.8 being the top.
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9 months ago
Have to exceed the limit to give a full picture I apologize. Continuing below:
 Still not an apparent tonsil swelling or "strep throat pain." No muscle pain and feeling of sickness apart from the fever feeling. 17-18 days after the incident, the fever hasn't come down below 37.5 Celsius the whole week. One side lymph node pain is 7/10. Yesterday, which was 19 days afterwards, I began feeling tonsil pain again, and the lymph node pain subsided interestingly. Went to the urgent care in the hopes of getting a test, but I wasn't really comfortable with the setting of the room (there were other people in there). So I said "I had a semi unprotected intercourse with a female and 8/9 days later I started feeling the symptoms should I get a test?" and the doctor said "you can give a urine test if you want" and to which I replied, "can I get a test for syphilis or hiv instead?" he said that I can get them at a clinic or health center and they don't do them here? I was very surprised. He got a throat swap and gave me clarithromycin. That's all he did. 
I had sore throat at the beginning of October. I had some extra amoxicillin at home so I started taking it, felt better and I didn't finish it. It came back around so I went to a walk in clinic and got prescribed another round of amoxicillin for 10 days. Had some slip ups and couldn't take all of them at the same time. I finished the course on October 27, and intercourse happened on the 29th night. Started feeling throat issues 10 days after I finished the antibiotic course. So it is either an antibiotic course failure or ARS symptoms. I told the doctor about the antibiotic course timeline so he thought that since I got prescribed the same type of antibiotics twice, there may be a resistance to it. 
What is your assessment? Isn't it strange?  
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Edward W. Hook M.D.
9 months ago
Welcome to our forum. Thank you for your questions. I’ll be glad to comment.

The encounter you described was low risk for STI‘s including HIV,  most people do not have STI’s. In North America less than 1/10 of 1% of women have untreated HIV. Even if your partner did have HIV and we count your encounter as penetrative, the risk of acquiring HIV is less than one in 1,000. In other words if she had HIV, which is unlikely, there is a 99.9% likelihood you would not be infected.  Further, your symptoms in no way suggest Syphilis and match quite poorly with recently acquired HIV. Recently acquired HIV typically begins to cause symptoms more than 10 days following an exposure and is comprised of severe sore throat, high temperatures, widespread muscle and joy takes as well as on occasion a rash all occurring at about the same time.. The symptoms are described like severe influenza. 

Normally, I would suggest that you not worry and not even bothered to test.   You however are clearly concerned so if you wish to prove that your symptoms are not due to HIV you could do a fourth generation combination HIV antigen/antibody test. If your symptoms were due to HIV the test would certainly be positive.

Finally, your description sounds as though you have been reading about what your symptoms may be caused by on the Internet. If you were doing this, please stop. The Internet is far, far more often, misleading, and helpful in situations like this. Suggesting that symptoms such as you may be due to HIV represent Information that is misinterpreted, taken out of context, out of date, or just plain wrong. 

I hope this perspective is helpful. EWH
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9 months ago
Thank you, doctor. Just to add some things. My throat pain turned into a more typical tonsilitis today. The fever around 37.8 Celsius, I also started seeing tonsillar exudates on both sides. On top of that, even though I don't have a runny or stuffy nose at this point, I feel a post-nasal drip, meaning I feel like I need to swallow some liquid stuck in my throat often. I don't think ASR tonsilitis produce any exudate. However, the last course of antibiotics and me getting sick again do  sound a bit odd in terms of timeline and symptoms. I have been feeling "off" for the past 20 days, and actual tonsil symptoms came back recently after healing up during the initial days. It is atypical for ARS to oscillate like that as well I think is that correct? 
You mentioned influenza, which is a viral infection. Should I keep taking my antibiotics? Could it be mono as well? I am not from Canada, and I will be permanently moving back home in 20 days. How should I approach the testing situation? Because IF I test positive, the time required for me to get an RNA test and all the others is not enough for my timeline. While I was looking at the demographics of HIV in Canada, the likelihood of me finding an infected partner is less than 1/10 I believe. However, you can correct me if I am wrong. I am thinking of getting an anonymous 4th gen Alere test when I go back home. Should I stop worrying about the potential for it being positive?  
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9 months ago
After reading your response once again, I retract both statements on the likelihood of finding an infected partner, "less than 1/10 of 1% of women" (which obviously means far less than just 1/10 like I understood at first), and you mentioning influenza. I thought you referred to my symptoms, but I didn't catch that you were talking about acute symptoms. I sincerely apologize. 
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Edward W. Hook M.D.
9 months ago
Thanks for the additional information.  It does not change my assessment however.  The more I hear, the more this sounds like any one of a variety of causes of sore throat/tonsillitis and is best determined by a visit to your doctor.  The list of possible causes is long- that you have not responded to amoxicillin makes it unlikely that this is a strep throat.  Possibilities include a mononucleosis syndrome which could be caused by several viruses  as well as many other viruses which are typically not tested for as there are no specific treatment.  Again the right thing to do is address this with your own doctor.

Regarding testing, if your symptoms were due to HIV, any HIV test would be positive at this time.  

You have one follow-up remaining.  EWH
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9 months ago
My symptoms worsened severely on Monday and Tuesday. I had an angry exudate, severe (39.7 Celsius being the highest) fever. That prompted me to go to the ER yesterday. My CRP level was 172.6, and my WBC was 12.5. They did a throat swab first but couldn't find anything. The doctor said the nurse might have swabbed the wrong area, so he did it again. After that, I had a CT scan, which came back negative. The fever prior to ER was 39.7, but when they triaged me and checked my temp, it was still 39.3, so they gave me three extra-strength Tylenol pills. After the CT scan, they took blood culture samples. They did a heterophile antibody test, which was negative, so I don't have mono. They gave me co-amoxiclav 500 mg 3x/10. I am feeling relatively okay now; they gave me steroids. The fever is under control.
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9 months ago
 I told them about the encounter and asked his opinion on testing. He was like, yeah, to clear things out of the table, so if you want to, we can. I ended up not taking it. What would you do in this situation? I know this is the last response I'll get, so I'll be blunt. Should I not worry about this exposure and get tested whenever I want when I go home permanently? You, one of my friends doing his I.D residency program, and two other doctors I've seen so far weren't keen on testing me for HIV, so it reassures me that I do not need it. Do you think this antibiotics course will fix my issue? I don't know the result of the second throat swab they did, so they didn't actually diagnose me with anything. I think the reason for this is that they didn't want to wait to initiate an antibiotics course. I think high CRP levels indicate a bacterial infection rather than a viral one, but the blood culture will be the definitive answer to that, hopefully. Also, do you think the heterophile antibody test is a reliable method for diagnosis? I already started with the antibiotic course. They gave me an IV dose in the ER, and I took one pill this morning, and I'm going to take the other one in 20 minutes. I feel better than I've ever felt in the past two weeks. It could be steroids, but even though their effects are fading in my blood, I keep feeling even better and better
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Edward W. Hook M.D.
9 months ago
I'm sorry that you are continuing to feel poorly but am glad beginning to feel better.  Several comments.

1.  The heterophile antibody test will diagnose some but not all mononucleosis.
2.  Your abnormal laboratory tests confirm that that you are ill but these are non-specific.
3.  The antibiotics and steroids may help but do not provide a clue to what is going on.  
4.  My assessment of the encounter you describe remains unchanged.  
5.  Regarding testing, I see no need from a medical or scientific perspective however, getting test might give you some peace of mind.  Only you can decide about testing but I see little downside as it will make you feel better.  If your symptoms were due to HIV, the test would be positive.  I remain confident that it will be negative.

I hope this perspective is helpful.  Sometimes knowing what is NOT present is as helpful as knowing what is happening.  On some occasions we do not know and are left being thankful that  our patients recover.  That may be your experience.

I'll leave the thread open in the hopes that you'll provide an update in a day or two.  EWH 
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8 months ago
Hi doctor, I am happy to report that my symptoms have been entirely under control since I returned from the emergency room on Wednesday morning. I haven't taken any Tylenol or Advil pills, I have no fever to record, and my sore throat is improving with exudates almost cleared up. The only thing left which is somewhat concerning is my night sweats. However, I connect it to my stress levels since I have to wake up at 4 AM to take my amoxiclav, and the fear of not being able to wake up is enough to keep me up most of the time. Night sweats have happened twice since the emergency room. Now that we know that the symptoms I had were not related to the ARS but to possible bacterial tonsilitis, can I have possibly had this infection in me since the last week of November? My incomplete initial amoxiclav usage (5 days followed by a couple of days break with another 3 days of use). Afterwards, getting prescribed baseline amoxicillin could potentially have weakened the bacteria but not wholly eradicated it. Therefore, once I finished that course, the problem arose again. Is it possible? My pill administration times were all over the place during those 10 days as well. I am much more careful this time. The hospital didn't contact me, so I am assuming that Amoxiclav could deal with whatever they found in the blood culture. I had never felt sicker in my life, and if it was due to a bad adherence to a drug regimen, I strongly recommend everyone to follow their course very carefully. 
As to the testing, I may never get tested for HIV unless I get into a monogamous relationship with someone in the future or have a health check-up.
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Edward W. Hook M.D.
8 months ago
Thanks for sharing your follow-up.  I'm pleased to hear you are feeling better.  

If you had bacteria in your blood cultures, the hospital would have called you.  You can assume that the blood cultures were negative.

Night sweats have many causes including reflex (heartburn).

I agree with your recommendation that it is important to take your antibiotics as directed  EWH
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