First of all my compliments for the very informative and professional website. Actually, I can find all the answers to my questions. Yet, I feel the need to ask you a question directly, although I already think I know your answer.

I am a man (52) living in The Netherlands. On May 13 I visited a female CSW. She offered me sex without condom, which I politely declined. Instead, we had unprotected oral sex - 2 way. Nothing to worry about. 

But 9 days after, I noticed significant swelling and inflammation of my neck lymph nodes (one was swollen and rubbery and painful). I started to feel the lymph nodes in other parts of my body (though less dramatic) I still feel them today. I developed some other (mostly mild) symptoms: mild headaches, some diarrhea. I never had (measured) fever, but had significant night sweats for days. I also did not have a rash other than folliculitis around the inflamed lymph nodes. I developed mouth sores. Overall I was not really sick, but I also did was not feeling normal. And the strange combination of symptoms worry me. 

I understand that I was not at risk for HIV and that there is no need to test.

Would the symptoms described above change that view?

Kind regards,

T.

You are correct that the exposure described was zero risk (or very close to zero) for HIV and low risk for all STIs -- both because HIV is rare in sexually active women (including CSWs) in your country and because there have been few or no reliably reported cases of HIV transmitted by oral sex. That said, I understand why your symptoms are concerning. There are two main reasons to seek HIV testing:  1) genuine risk, with or without typical symptoms that might suggest an HIV infection; and 2) reassurance. People at little or no risk but nevertheless worried about the possibility of HIV often are tested just to be confident they can stop worrying.

I would place your need for testing as low but not quite zero from the first perspective: in theory symptoms like yours could occur with a new HIV infection. However, they also result from many trivial (mostly viral) infections. However, from that perspective plus your obvious worry (otherwise you would not have come to our forum) it would be reasonable to be tested for reassurance purposes. I would advise visiting a physician or clinic with STI/HIV experience. If you're in or near Amsterdam, the GGD Clinic would be ideal; it's one of the world's most respective centers for sexual health, HIV prevention, etc. https://www.ggd.amsterdam.nl/ or the Dutch Institute for Public Health (RIVM). If Amsterdam isn't convenient, my understanding is that there are similar clinics nationwide.

Another option would be to contact your CSW partner, if you are able to do so, and ask if she is willing to be tested (or retested) for HIV. If negative, you would know for sure there was no risk.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for your reply.

I do not understand the comments related to genuine risk. I always thought that oral sex was no risk for hiv. So not sure how to interpret your comments. The story above is genuine. I told myself several times over the last week that I am not going to be the first to be infected by oral sex (as mentioned on this site) but your reply is worrying.

Kind regards,

T.