[Question #1736] 14 days post exposure symptoms

45 months ago
Dear Dr,

I had a sexual encounter two weeks ago with a woman who isnt my partner.  During this encounter  - 
I received unprotected oral sex;
We had three separate bouts of protected sex, twice in the night and once again in the morning;
In addition to sex we did some foreplay, mutually and solo masturbation both before and during the sex;
The woman was on her period, there was blood on the outside of the condoms, bedsheets and on my hands;
It is possible that I touched my mouth and penis with this blood on my hands;
The status of the women is unknown.
  
There wasn't however any penetration without a condom, I don't believe it slipped either time (three bouts, three condoms) and none broke.  I have since spoke to the woman about my concerns, she confessed she is no angle (who is) but says she practices only safe sex, and she also confirmed that no unprotected penetration took place or that the condoms broke.  Like me she couldn't say for sure whether at any point the condoms slipped.

As mentioned about two weeks have passed.  Last couple of days I have been getting some possible symptoms - 
Sore neck, front sides and back;
Pain in the arm (inside of the elbow) the area blood is normally taken (right side only);
hot and bothered with temperature, hot and cold flushes;
pain that seems to come and go in my armpits;
tight throat, lump in throat and swallowing lots;
hot neck;
hot ears;
the skin under my chin on my neck feels 'loose'

I am trying my best not to touch these areas but want to try and check if I have swollen glands.

I am very worried, very anxious, feeling very guilty and can't think of anything else. I haven't slept particularity well in days, can't really concentrate in work and don't have much of an appetite.  

I was actually contemplating an overseas trip to do the 10 days post exposure test at great expense to find out my status, I thought I would write to you first thou.  Other than HIV what STD's could I be at risk of? 


Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to the Forum.  I appreciate the confidence that you have placed on our site.  I'm pleased to comment and hope that you will find my comments reassuring.  The event that you describe put you at no meaningful risk for infection.  Most importantly, you have described no contact which placed you at meaningful risk for HIV or any other STI.  Condom protected sex is safe sex, receipt of oral sex does not put you at risk for HIV and is low risk for all other STIs, and the possible transfer of her blood or genital secretions to you, including to your genitals is likewise a no risk event for HIV and STIs.  In addition to these facts, further supporting the low risk nature of your contact:

1.  Most women do not have HIV or other STIs.

.2.  Even if you contacted an infected person, most exposures do not lead to transmission of infection.

3.  The symptoms you describe are not the least bit suggestive of ANY STI, including HIV and are far more compatible with anxiety and guilt-related hyperawareness of sensations that are either coincidental or would have been ignored by you if you were not so worried.

I see no reason for testing at all.  If you must, you could be readily tested for the most common STIs, chlamydia and gonorrhea with a urine test,  There are no 10 day tests which do not have a substantial false positive rate, irrespective of what the advertisements tell you. 

If you must have a test to convince you that you were not infected, I would suggest you contact your partner and ask if the two of you could go for comprehensive testing at this time.  EWH

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45 months ago
Dr,

Thanks for your reply.

I understand the statistics pretty well I think, she is from a country where roughly 1% of people are infected, transmission is low and a condom was used; all multiplied together would make it extremely low risk.

That said, there were a few things she said afterwards, like she has never been tested, had recently had an all over body rash and that she has had many partners.  I am not one to judge, but am a stats man so appreciate the more partners we have had the more risk to which we expose ourselves. 

Now assuming the worst case scenario, that is that the recent rash she has was ARS would her viral load have not been very high?  And again, assuming the condom slipped even briefly, how much more risky would this encounter be in your opinion?

As for the symptoms, I have what feels like a fat neck so presumably swollen, a heavy saggy feeling under my chin, and like a burning sensation both under my am pits and in the elbow pits, I feel tired all the time and have back pain.  The arm pit pain is probably causing the most anxiety as I have read lymph nodes swell here about two weeks after exposure, and this seems like a huge coincidence?

I cannot feel any lymph nodes or see any at this time, but to be honest I am not sure I would know where to look anyway, but the burning sensation is very real.  I don't have a rash a this time.

Are these not ARS symptoms?

You are spot on about my anxiety and guilt, it is currently through the roof.




Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

You really are worrying needlessly.  Sure, if she had the ARS her viral load could be high and that is a risk for sexual transmission but the odds of that being the case are staggeringly low.  Further, as long as the tip of the penis was covered by the condom, as it was, the condom will prevent HIV.

Once again, the symptom you describe are not ARS symptoms.  Most lymph nodes swelling that occurs with HIV is painless so it is unlikely that your arm pit swelling reflects swollen nodes and even if there were swollen lymph nodes, such findings are non-specific with HIV being a relatively rare cause. 

EWH

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45 months ago
Thanks Dr.

I appreciate your response, but I was actually hoping you would have gone through every symptom in turn and say whether they were ARS or not rather than just a blanket no, I think this would help with the anxiety I am experiencing.

I have a really hot forehead today and a splitting head ache.  
My neck continues to feel sore and my shirt feels super tight on my neck even thou it isn't, the collar bothers me when normally it wouldn't.
Still no noticeable lumps under my arm but the burning / dull pain persists.
The same burning / dull pain persists in my elbow pit.
Tight / saw jaw.
Lump in throat.
I have ear ache that seems to come and go particularity behind the earlobe; In fact if you drew a line from my ears down my neck and met under the chin the whole area feels tight

Why do you suggest that I "contact your partner and ask if the two of you could go for comprehensive testing at this time" if you don't see the need for testing?  Do you mean my regular partner or the women I had the encounter with?  Should I refrain from having sex at this time?

I appreciate this is my last follow up question so I would really appropriate a detailed response.

I would also like to thank you for the service you offer, my state of mind since yesterday has dramatically altered (I was basically having a panic attack for about an hour).  




Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

I will not go through your complaints symptom by symptom.  Medicine does not work that way.  Health care providers go to school for years to put the pieces together.  Breaking them apart does not serve any useful purpose and if anything is counterprpoductive.

I was referring to the casual sexual contact you mention. the basis of this suggestion is that if she infected you, her test would be positive.  You cannot get infected from an untreated, uninfected partner.  I see no reason for you to refrain from sex with your regular partner as I see your exposure as having no meaningful risk for you. 

As you point out, this is my third and therefore final response to you.  My sense is that you have a large amount of fear, anxiety and perhaps guilt over your exposure.  I would suggest you consider seeking the advice of a trusted, confidential counselor to help you work through the concern you have as they do not have a scientific basis.  I hope my comments have been helpful,.  EWH

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45 months ago
Ok thanks.

So to summarise these are not ARS symptom and I need to chill and move on?

Thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Correct,  thread is now closed.  EWH
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