Hi. Exactly 33 days ago i had episode with a sw. In the beginning she rubbed the outside of my penis with the outside of her wet vagina for about 30secs. Then she put a condom on me and processed to have vaginal intercourse. The intercourse lasted for about two minutes. While withdrawing saw my condom was not on my penis but was stuck to the outside of her vagina, with the semen inside her vagina. My penis looked dry and it didnt seem like it touched her vagina for a prolonged time other than touching the outside of her vagina lips while withdrawing, but i am not 100% sure. After exactly four days after it, i woke up with very soar throat, runny nose and nasal congession. I drank some Nyquil and took some augmentin, i had two night sweats and then after 4days of being sick and feverish but no high temperature started feeling better. I felt good for 5days and after that my right elbow started paining severely. Then i had a stiff neck mainly my right side and then my whole body started aching severely like never before in my life with cramps all over. I could not see any distinct swollen lymph node. On day 23 after exposure, which was the worst day in terms of body ache, and 9days since the pain started i had slight redening of my cheeks and forehead for about 12hours, felt feverish but no high temperature. Then i started feeling better and had three more days of night sweats. But i had slight back pain here and there and chills,. Then on the 28th day till today i have my muscles all over my body shaking and twitching by itself and i developed a stiff neck day before yesterday which lasted one day. But the muscle twitching continues all over. I am really worried that i have got hiv. I read that herpes sometimes cause muscle trembling and shaking but i had no real breakout. Never had high fever but felt feverish. Now on the 33th day i feel fine except for muscle trembling. Did i just go through ars? Have i seroconverted? I have had frequent and very yellow urine for two

Sorry doctor i made a mistake, i meant to say the semen was inside the condom not inside her vagina. Also i have been having very frequent and very yellow urine for the last two weeks even though i drink significant water.

I am not sure why you have posted this repetitive question.  As you may know, Dr. Handsfield and I share the Forum and, despite differences in verbal style, do so because we have not disagreed with our assessments and advice to patients in over 30 years of working together.  Dr. Handsfield's assessment and answer to your questions is the same as mine.  for that reason, I have pasted in my earlier replies to you. 

From my initial response:

“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 you have mentioned.  I hope these comments are helpful.  Please let us know the results of your test. EWH”

And from my second reply to your follow-on question:

“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 be 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”

My advice and assessment has not changed and I know that Dr. Handsfield agrees with me.

Finally, with respect to you new additions to your questions:

1.  Muscle trembling is NOT a symptom of HIV.

2. Yellow urine and urinary frequency are not signs of HIV or any other STI.

I have closed your earlier post.  You may ask up to 2 follow-up questions for clarification.  EWH

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Dear doctor thanks for your response. I am really sorry if i have offended you. I am just extensively concerned about my current situation. Please answer few of my questions.  Can redness on two cheeks and forehead that lasted less than a day be considered a rash? There were no distinct centres or bumps, only pinkish-redish appearance. Also now I feel completely healthy, but my body muscles are trembling and twitching all over my body without any pain. And do you think ars symptom to appear only after exactly 4days and 12hours is unlikely? Also my muscle pain and ache came later on when my sore throat was gone. Is this inconsistent with ars? My body temperature was never more than 100. I asked around and no where in toronto i found duo test, so i was asked to wait 6weeks. I also had a stiff neck day before yesterday for only one day. Can night sweats with out high body temperature be considered as ars symptom? What worries me most is my body pain, fatigue and malaise, which came after 5days separately when other symptoms were gone, and lasted around 10days from 19th to 28th, which i dont remember ever happening before in my life. I have heard that herpes can be transferred with skin to skin contact, so could it be that I got the hsv when she rubbed her vagina with outside of my penis, i would actually be relieved if i caught herpes and not hiv. I checked two months ago and i had no std, not hiv, hsv or any other common std. So could an initial infection of hsv be similar to what i got without any sores or blisters when she rubbed her vagina? I have heard hsv is very very common and is of no real harm, infact 1 in 5males in usa has it. Also i read that hsv can cause muscle trembling. I am sorry once again if i have offended you in any way doctor, that was not my intention,  i was wondering if dr hhh had anything different to say or not. Thank you.

Your questions are repetitive.  Asking the same question does not change the answers.  I have already informed you that the symptoms are suggestive of the ARS but do not align perfectly and given your obvious anxiety, therefore recommended testing.  I suggest you re-read my earlier replies.  I also acquired regarding your statement regarding the availability of 4th generation, DUO tests in Canada and learned that these tests have been used and are widely available in Canadian public health clinics for several years. 

Night sweats without a temperature are, like so much of what you describe are non-specific. 

For symptoms such as yours to be due to herpes without lesions would be most unusual.

Your questions suggest that you are searching on the internet for information.  This is a bad idea, what you will find there is often incorrect or taken out of context.  Rather, I would suggest you seek Public Health officials in Toronto who I know provide excellent services.  When you do, I am confident that they too will tell you that you acquired no STI, including HIV from the low risk encounter you describe.  At that time, it would be best to seek help in dealing with the guilt and anxiety which also seem to be impacting you.  EWH

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Dear doctor, thank you for your reply. Will you please comment on few other things? This is just for my peace of mind. From your vast experience,  what was the earliest when you have witnessed ars symptom to start? my symptom started 4days 12hours later with a sore throat. Also from your experience, did you ever come across ars rash which was just the pinkish red on cheeks and forehead which lasted less than a day? Also my body pain was mainly situated on the right side of my body? Can you please comment on that? That will be it for me. I will not be inquiring any further and just go get tested.  Thank you very much doctor.

In my experience, I have not seen the ARS begin sooner than 6 days after exposure. 

I have seen brief, transient rashes in patients with the ARS but I have not seen the rash manifest only as pink cheeks. 

Body aches in patients with the ARS are typically bilateral.

This is my third reply to your questions and therefore, as per Forum guidelines, this thread will be closed later today.  Please note that the forum does not permit repeated anxiety driven questions by the same users. This will have to be your last one; future new questions on this topic will be deleted without reply and without refund of your posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tends to simply prolong such anxieties, when the real answer normally should be professional counseling; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.  EWH

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