[Question #12250] HIV

9 months ago

Hi Doctors. I (male) had vaginal sex with a female of unknown HIV status and the condom broke during sex. To be safe I began PEP within 48 hours. On the 10th day of being on PEP the girl I slept with went to get tested using a 4th generation test and it came back negative. She hadn't slept with anyone in the last 2 months (other than myself) so I'm assuming that result is conclusive.

Anyway, after I found out she tested negative, I went to a massage parlor and received a hand job at the end of the massage. I didn't notice any cuts on the masseuses hand but she rubbed the tip of my penis with her thumb for a long time. That kind of worried me so I just continued to take my PEP medication (Truvada and Tivicay.) 9 days after the massage I came down with a slight fever (100F), body aches, fatigue, slight cough, slight congestion and a slight sore throat. These symptoms lasted about 6-7 days.

My question is, is there any chance this could be HIV ARS and I was infected from the hand job? Perhaps the masseuse had a cut on her finger and blood entered through my urethra when she was vigorously rubbing it? I just don't know how getting HIV would be possible especially considering that the Truvada was acting as PrEP since I had been on it for 10 days when I was originally taking it as PEP (correct?). I'm just very confused here and would like some guidance on next steps. Thank you so much!

Edward W. Hook M.D.

9 months ago

Welcome to the forum. Thank you for your questions and for your confidence in your service. If you had asked following your encounter, whether you needed PEP or not, my response would be that it was almost certain that you were not exposed. In North America heterosexual women have HIV less than one percent of the time and, following a single exposure to a person with untreated HIV, the risk of HIV acquisition is less than one in 1000., Your statistical risk without knowing anything else about it. It was less than one in 100,000.

Your risk of infection remains zero. Receipt of masturbation is a no risk activity, no matter how vigorous and irrespective of whether your partner’s genital secretions are transferred to you during the activity. This fact is agreed to by the CDC, the WHO, and both of us on this forum. There was no risk of acquiring HIV and even if you had been exposed, your PEP would have prevented infection.

There is no reason for concern going forward and no reason for testing. I hope that this information is helpful to you. It’s time to move on. EWH.

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9 months ago

Hi Dr. Hook,

Thank you for your quick reply.

Just to clarify, I had been taking PEP (Truvada and Tivicay) for 10 days and then I received the hand job from the masseuse. Therefore, was the Truvada acting as PrEP for the hand job exposure since I had been on it for 10 days?

Also, I just want to make sure there is no chance that my slight fever (100F), body aches, fatigue, slight cough, slight congestion and a slight sore throat were HIV ARS since they occurred 9 days after the incident and I know that's typically when HIV ARS occurs. It was strange because I was around other people when I had those symptoms and nobody else got sick, so that worried me that it wasn't just some cold.

I apologize for the additional questions. I really appreciate your time.

Edward W. Hook M.D.

9 months ago

I understood that you were taking PEP and that it would act as PEP in the no risk encounter you described. As I said above, "Your risk of infection remains zero." The answer will not change.

If you wish to prove that the symptoms that you are experiencing are not due to HIV, you can test. If they were due to HIV, the test will be positive. I remain confident that if you test, the test will be negative. EWH

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8 months ago

Thank you again, Dr. Hook. I really appreciate your advice. I have one final question regarding HIV ARS. Every time I have a sexual encounter and get sick afterward, I typically worry about HIV ARS. To better understand the symptoms of ARS (since I've read slightly differing responses here), does ARS cause congestion and a slight cough? From what I understand, if you have a slight cough and congestion, those are typically not symptoms of HIV ARS. I just want to be 100% sure that the following symptoms—slight fever (100°F), body aches, fatigue, slight cough, slight congestion, and a slight sore throat—are not HIV ARS. I will get tested, but I know I have to wait six weeks after exposure, and to be honest, the worry is getting to me. So getting this question answered about HIV ARS will be very helpful. Thank you again for all your help; it means a lot to me.

Edward W. Hook M.D.

8 months ago

It is perplexing that you become ill following new sexual encounters. This suggests to me that you are anxious and probably overly anxious about your risk for HIV and other STIs. Please know that most people do not have HIV and that most single encounters (far less than 1%) of unprotected encounters with untreated HIV infected partners DO NOT lead to infection.

Cough and congestion are not signs of the ARS. The classical symptoms of the ARS are rather severe and include high fever, sever sore throat, widespread severe muscle and/or joint aches and, sometimes, a rash or diarrhea. I wonder if the symptoms you experience are anxiety related and reflect looking too hard for symptoms and, as a result, noticing otherwise normal sensations.

I hope the information I have provided is helpful. Take care. I'll be closing the thread now. EWH

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