[Question #1601] Potential HIV exposure, all ars symptoms. Very scared. Toronto

46 months ago
I had an encounter with csw on 5th dec. In the begining to my dismay she started rubbing outside of her vagina with my penis, I was taken aback by this, this was at max 20sec, no penetration occured I am certain but outside her wet vagina touched outside of my penis. I told her to put on a condom and she did and moved on to vaginal intercourse. The vaginal intercourse lasted around 5mins, and just 2mins before ejaculation i changed position with my intact condom, and after 2mins while withdrawing i saw the condom being stuck outside of her vagina and the cum inside the condom, while withdrawing my penis might have touched the outside of er vagina for a second. I checked my penis it didnt seem wet from her vaginal fluid so i deduced the condom slipped while withdrawing, hopefully. I made nothing of it and forgot of it. Exactly 5days later I woke up with a very sore throat and nasal congestion and feeling feverish. For 4days I felt very sick and weak with two days of night sweats. On 5th day I felt much better with only runny nose. On 19th of december exactly 14days after exposure my right arm started aching severely and then other parts of my body mainly my neck and then all over my body, felt feverish, this lasted till yesterday. In this period the main symptom was severe body ache and cramps like never before in my life. My two cheeks, forehead and upper chest became redish for a day and on second day the redness was gone and the skin was flaky. During this time I had frequent urination with yellow urine, also night sweats on three nights although no high fever, just felt feverish and weak. No severe headache or high fever, but body pain like never before in my whole life, one cold sore which was there for only one day. I really feel like I have contacted hiv, as I almost never ever fall sick and when I do never with serious body pain like this time, also I got a weird sensation around my groin region and pain. Was this ars? very worried. HELP! I still have backpain
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Welcome to our forum.  I will try to help.  From your description there was no meaningful risk for HIV from this encounter.  First, most commercial sex workers do not have HIV or other STIs.  Further, in the case of the exposure that you describe, there was no unprotected penetrative sex.  The sort of rubbing you describe (frottage) is a form of masturbation with no risk for HIV.  Similarly, condom protected sex is a virtually no risk event.  When condoms come off as a man is withdrawing form a sex partner, they have done their job and protected for HIV and other STIs. 

At the same time however, the flu-like illness you describe is consistent with the symptoms of the ARS (Acute Retroviral Syndrome) and occurred at a time after your exposure when it might occur.  While I remain confident that if your activities were as you described, you did not get HIV however, at this time my recommendation would be to go and get a 4th generation, combination HIV antigen/antibody test to prove that your symptoms were not due to HIV but were a badly timed, coincidental, non-HIV viral infection of the sort that most people get every once in a while.  If your symptoms were due to HIV, the 4th generation test will be positive at this time.

I should also point out that when at risk persons (you were not) have flu-like illnesses, over 98% of them do not have HIV but have other illnesses (non-STI). I point this out to indicate just how low the odds of infection are for you.  Testing will provide you with peace of mind.  when your test in negative, be confident that you did not get HIV from the encounter with the CSW yu have mentioned.  I hope these comments are helpful.  Please let us know the results of your test. EWH

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46 months ago
Dear doctor, here in Canada all tests are antibody tests. So how long should I wait? Also, I knew that the ars symptoms dont come separately, also my sore throat came on the 5th day, is that not too early? then I felt good for around 4days. Also, when I got my sore throat and nasal congestion my roomates became sick with a cold within 3-4 days, both of them along with sore throat.  Also you and doctor handsfield mention that nasal congestion and phlegm are not ars symptoms. Also how does the ars rash look like? my rash lasted only around 20hours, and it was barely redish skin on my cheeks and some on my forehead, and extremely small pin like spots on my upper chest like 3 to 4 only. My worst symptom was the muscle ache which was very bad especially my right side, left side not as much, but i did not feel any swollen lymph node, but when my muscle ache started I asked my roommates if they got it too, but they didnt, so my worst fear is the severe muscle ache.. My fever was never high, i dont know if i can call it fever at all. Right now I feel much better and thats what scares me, as I feel i seroconverted. But my sore throat came in around 10days before body ache and rash, the redish apearance that lasted a day appeared 8days after body ache came. I felt chills here and there and very yellow urine. Is yellow urine ars symptom? Is one-two minutes enough to get me hiv infected? Could it be hepatitis or herpes by any chance? By any chance can symptoms come separately? I remember you mentioning in another forum that ars symptoms come together not separately like mine did. The sexworker i met frequents ottawa, toronto area and posted her last ad on 16th december. She also kept on mentioning to use condom. Could I actually have been infected with hiv? Couldnt it be herpes or hepatitis? Do they give similar symptoms?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

I was not aware that Canada had not adopted use of 4th generation, antigen/antibody tests and would urge you to verify this.  The rest of the world has shifted to these tests, from the U.S. to most developing nations.  Even if the tests available to you are antibody only tests, you will get much useful information by testing at this time, more than 4 weeks since your possible (unlikely) exposure since over 90% of persons will have reactive antibody tests at this time and the proportion would be expected to b e higher still if your symptoms were due to the ARS.

As far as whether your symptoms match the ARS or not, they certainly do not match perfectly.  As you point out, cough, nasal congestion, and sputum production are NOT part of the ARS.  On the other hand, the other flu-like symptoms you report - sore throat, fever or feverishness, transient rash and severe muscle aches are often seen in the ARS and they do tend to overlap in terms of when they appear (i.e. they do not occur sequentially over time).

Perhaps I over interpreted the level of concern that led to your questions.  As I said above, when all is considered, it is quite unlikely that your symptoms are due to HIV (and even less likely to be acute hepatitis B or herpes) but I also thought (perhaps reading between the lines) that you were concerned.  If this is the case, a negative HIV blood test would be strong evidence that your recent flu-like illness not HIV or related to the exposure that you describe and would allow you to confidently move forward without concern.  I hope that this rationale makes sense.  I am trying to address what I perceived to be your concerns.  EWH

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