[Question #1492] Very Scared! Risk, symptoms, and is testing necessary?

83 months ago
Dear Dr. Handsfield, Made a huge mistake. 25 yo. virgin. In Arab Gulf country for bit. Went to get groceries. Met and had sex with prostitute from Ghana. She put condom on me then oral for 10 seconds, then sex for 10 minutes and finished inside. Went to bathroom, took it off, inspected it by pushing semen to tip, pushed hard twice and there was no leakage and not broken. 
Day 12, tenderness right testicle went away within 48 hours. 
Day 17 slept in new room maybe under AC.
Day 19, slight night sweat.
Day 20, night sweat changed shirt went back to bed. Felt sick that day, but went out. Temp not above 99, but felt hot. Not sweaty. Slight fever but very mild, not worth using thermometer. Sore throat. Reddish face and eyes. Slight nausea only in car on way home from mall. Appetite loss. Ear pressure. No nasal congestion.
Day 21, (changed room&no night sweat) Felt sick, but better then yesterday. Temp not above 99. Mild sore throat. Nasal congestion severe and using tissues to clear. Sinus Congestion. Sneezing little when cold. Pressure ears. -Only sick for 2 days, mild but sick nonetheless. Function slightly impaired, but able to go out if necessary.
Day 22, MUCH better than before! Didn't feel sick like the 2 past days and almost normal 85%. Wake up very stuffy nose and a lot of yellow mucus have to clear. Slight sore throat. Stuffy nose severe. and sinus pressure.
Day 23, much better than the day before (90% normal). Severe stuffy nose. Wake up and clear yellow mucus. Sinus pressure. Slight sore throat, maybe from nasal drip.
Day 24, much better than the day before (97% normal), but still very stuffy nose, yellow mucus, sinus pressure in face. Slight sore throat. Runny nose imminent maybe.
Please advise risk? Were these symptoms of ARS? What scares me was 2-4 weeks. And began with a little night sweat. No high fever, no rash. All very mild symptoms. Maybe seasonal change or cold. Was it bacterial or viral? Was taking 1000mg emergen-C vitamin daily for 4 days. Started augmentin now for congestion. 
Edward W. Hook M.D.
83 months ago

Welcome to the Forum.   On our Forum Dr. Handsfield and I split all non-herpes questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing your questions.

Before I comment on your symptoms, let me provide some more general background information.  Most commercial sex workers, even those from African nations where HIV is relatively common, do not have HIV.  Further, even when having sex with an infected partner, most exposures (about 1 in 1000 for vaginal sex, none when receiving oral sex) do not lead to infection.  Further, use of a condom throughout sex reduces the risk of infection still further, more than 1000-fold.  Thus, from your descriptions, even if your partner had HIV, which is doubtful, your risk for HIV from the encounter you describe was less than 1 in a million IF she was infected, which is also unlikely. 

As for your recent symptoms, they are not typical of the ARS.  Classically the symptoms of the ARS are relatively severe with high fevers, muscle aches, severe sore throat and sometimes a rash or diarrhea.  Your illness sounds more like the sort of non-STI viral infection most people get from time to time.  I would not be worried about HIV from this exposure if I were you.   If you are worried however, you could now seek testing with a 4th generation HIV antigen/antibody test.  When the result is negative, as I am confident it would be, you can be completely confident that you did not get HIV and more forward without concern and without a need for additional testing. 

I hope my comments are helpful.  EWH

83 months ago
Dr. Hook, 
Thank you for your reply. Do you believe that sinus congestion; very stuffy nose, pressure in facial sinuses, ears, mucus, a little runny nose are not symptoms of ARS? These are ultimately the only remaining symptoms that I had during and until now. It's taking time to go away. I'm starting to believe it is a respiratory infection and seeing other people with cold symptoms at the mall today was a little reassuring. 

There was no yellow mucus today, maybe due to the Augmentin? But mucus nonetheless... Still congestion... The sinus congestion is somewhat severe in face and uncomfortable. Started to take Panadol Cold/Flu to relieve it and its working a little. Lastly, last 3 days I was getting much better and almost normal, but then today I felt tired, a little hot, not as much energy as the day before. Could this be the result of the antibiotic? Does it also cause loss of appetite?

Lymph node on right side of neck was a little swollen today for the first time. Is that normal? I must say, I did have a rash the first day I was sick, but it was within 1 minute of eating spicy indian food from a new place, it was on the very top front thigh of my right leg, it was only 2 inches then disappeared completely after 5-10 minutes. This had me shaking. Allergic reaction and no correlation to ARS? 

Also is it safe to say that when an individual has ARS, if they do then its severe? All the stories I have read are severe or they didn't have any. 

Thank you doctor.
Edward W. Hook M.D.
83 months ago

This is a repetitive question.  I said "As for your recent symptoms, they are not typical of the ARS" above. I do not think your symptoms are at all suggestive of the ARS. 

Antibiotics can certainly cause a person to loose their appetite, as can community acquired viral infections.  Swollen lymph nodes are non-specific and common in persons with minor viral illnesses of the sort you describe. 

Your rash in no way suggests ARS. 

I urge you to relax and move on as I said in my initial reply.  EWH

83 months ago
Dear Dr. Hook, 
Thank you for the reply. I am moving on gradually. Cant test now and have to wait, so please understand that is what is driving me crazy. When I think about infection I become terribly nauseas. Anyway, my final follow up. 
- So the nasal congestion and sinuses in face are not symptoms of ARS but rather Resp. infection?
- The right testicle pain prior to illness was not caused by pressure from lymph node in groin?
- Feeling legitimately sick for only 2 days at start is not long enough (it would have to be longer)?

That's all. Thank you very much doctor. Regards.
Edward W. Hook M.D.
83 months ago

Final reply. As per Forum Guidelines, this thread will be closed later today. 

Correct, nasal and sinus congestion is not a symptom of the ARS.

The transient right testicular discomfort you describe is not suggestive of any STI, including HIV.

Feeling sick in the way you describe for two days does not suggest HIV.

Time for you to relax and move forward without concern.  I hope my comments will help you to do this.  Take care  EWH