[Question #12790] MSM Oral Sex on Prep Follow Up

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5 months ago

Doctors, I anticipate your disappointment that I have returned so soon, and apologize in advance.  I have occasional receptive oral sex with men of unknown status, so I started Descovy for daily Prep in mid-Dec 2024. I take it daily without missing doses.  On Feb 11, I took my 3-month test through MISTR so that I could continue my prescription and it was negative.  I got sick on Feb 28 with a fever followed by a sore throat that was not severe and a dry cough. I went to the doctor on Mar 1 and they prescribed augmentin 875 and a cough medicine.  The fever of 101 went down to the 99 range and stayed around for a few days.  Within a day or so of starting Augmentin, I developed oral thrush (red spots covered in white film) that made everything taste different and had 7-8 mouth ulcers pop up simultaneously.  I also had several sores develop on my face that were not herpetic and not on my lips/mouth.  They have mostly healed along with the mouth ulcers. It's now Mar 15 and my dry cough has gotten intense and the sore throat is still present. I am getting tested again today, but I completed an Oraquick test yesterday that was negative. I haven't slept more than a couple hours a night in 2 weeks. 

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5 months ago

So many other seemingly reputable sites (The Body, HIV I-base) say things that contradict the advice you provide.  I have also read hundreds of questions submitted here.

Is it still the case that no one has ever returned HIV-positive that has asked about their symptoms here? Is it correct that you can't have ARS symptoms while on anti-hiv medication like Prep as I read elsewhere here? Am I correct that if I had actual ARS with all these symptoms that the oraquick test would have been positive?

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5 months ago
I went to the Doctor again today who said I have atypical pneumonia and prescribed more doxycycline, prednisone, codeine, and nystatin for the thrush.
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H. Hunter Handsfield, MD
5 months ago
Welcome back, but honestly I don't understand the reason. I see nothing in this description of your exposure and symptoms that were not discussed in your recently closed discussion with Dr. Hook. Did you think he might have changed his mind? Or that I might have alternate advice? Neither has ever happened on this forum.

Perhaps you are concerned about the possible oral thrush? Your description ("red spots covered in white film") doesn't fit well with yeast infection (thrush), but even if you have it, thrush is a common effect of antibiotics like Augmentin. As discussed last time, all your other symptoms are NOT typical for a new HIV infection.

Without knowing the details, I can't comment on what information we have provided that conflicts with other sites:  if you'd like to be specific, perhaps I'll have something to say.

Yes, it is still true that in the 21 years of this and our earlier forum at MedHelp.com (now defunct), with thousands of questions from persons concerned about HIV after a possible exposure, nobody has yet told us they tested positive. You will not be the first. If and when it finally happens, surely it will involve a truly risky exposure and not one with near zero risk like yours (think unprotected anal between men and so on) and will not be someone with symptoms that fit poorly with HIV as the cause -- as you are experiencing; or with atypically negative test results. On top of all that, you now have an alternate diagnosis:  HIV is not a cause of atypical pneumonia (or any pneumonia at all, or cough and other symptoms you report). And viruses that cause atypical pneumonia can cause oral ulcers as well; HIV rarely does.

And yes your Oraquick or any other test would be positive if you had ARS. The symptoms or ARS are not caused by HIV itself but by the immune response to it -- and immune response means antibody is present and detectable.

You don't have HIV. Believe it, suck it up, and move on! Best wishes for prompt recovery from your pneumonia and other symptoms.

HHH, MD
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5 months ago
My 4th gen test results from yesterday are negative.  Thank you for your reassurance and expertise.  
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H. Hunter Handsfield, MD
5 months ago
Glad to hear it but of course not surprised!

Thanks for the thanks. Take care and stay safe.
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