[Question #1786] ars symptoms/ test history

45 months ago
Hi Drs my risk was unprotected vaginal sex two times with ex gf from 10 yrs ago.Sex was not rough but she was kinda dry at first due to menopause. Dont know it that matters risk wise. Found out later very promiscuous and maybe csw for period of time.Says she was tested for everything but who knows. Ugh. Together weekend of Jan 15, symptoms stared around feb 3rd couple of nights mild night sweats,mild sore throat. Achy joints and sore muscles which remain. felt feverish, took temp from 2nd night on and was normal thruout this ordeal. later in that week chills where had to put on pjs to keep warm,no fever. and also a itchy rash which woke me outta my sleep.Rash was by knee 2in by 1 inch and was basically gone by am however very small red bumps remain there. arms and legs excessively fatigued also remains but not as bad as first couple of days.. Pain in Inguinal area which remains possibly swollen node. also can feel salivary glands.Dry cough thruout. loss of appetite and just last night nausea. Tested 3 wks oraquick swab . 4 week Insti rapid test finger prick at hiv clinic, and this week 2 oraquick swab at 5 and 5.5 weeks. Mon will be 6 weeks and plan to test at clinic. My question is what are the chances that this is ars,and if so why are symptoms remaining and more like the nausea just now showing up? Are my tests likely to change from neg to pos. I read a medhelp post by dr hhh where he said he hadn't seen a 4 week neg turn pos later. Does that still apply. And if this is truly ars,,wouldn't my 4 week Insti antibody test have been pos at that point due to antibodys being produced.. Can i rely on the two oraquick tests during the 5th week figuring that they would have picked up something as well.I have read that there have been questions of their sensitivity. Have been very anxious, stressed and tense to the point of losing sleep. Unfortunately thats just my nature. Thanks for the work that you do! It helps worriers like me..
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our Forum.  I'll be pleased to comment.  All in all and despite the fact that your recent partner may have worked as a CSW, the odds are quite low that your current symptoms represent the ARS.  Here is my reasoning:

1.  First, HIV is rare in women with only about 1/2 of 1% of American women having HIV and those ho are infected are disproportionately injection drug users, not CSWs.  Further, the infection is less common in women over 40 than younger woman and if your partner was menopausal she is likely over 40.  Finally, even if she had HIV, the risk of acquisition of infection from vaginal sex with an infected partner is less than 1 infection per 1000 acts of intercourse. Thus, the odds are statistically against you being infected;

2.  Your flu-like illness with fevers, sore throat and perhaps swollen lymph nodes has some of the characteristics of the ARS but ARS symptoms are typically quite severe,. Further, the rash of the ARS is typically generalized, not localized.  Finally, in this category, when studied only about 1% of persons with ARS-type symptoms turn out to have HIV, the rest having non-STI viral infections, like influenza and it is now flu season.

3.  Your negative tests argue strongly against the ARS.  The ARS occurs as the body begins to make antibodies to the HIV virus and occurs over a few days.  Thus while an antibody only test might be negative at the onset of the ARS, tests a week or more later would be expected to be positive if your symptoms were due to the ARS.  Thus your more recent negative antibody tests also argue strongly against HIV. 

Bottom line, I am confident that your symptoms are not suggestive of ARS. Technically your antibody test results are not definitive yet but they are close.  When you test next week you can completely rule out the possibility of HIV by being sure that you are tested with a 4th generation, combination HIV antigen/antibody test.  These tests are definitive at 4 weeks and, in your case, I am confident the test will be negative.

I hope this information and assessment is helpful to you.  Take care. EWH .


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45 months ago
Thank you for your reply Dr Hook!  My ex is 50 yrs old, and its rumored that perhaps she was csw. Not sure.  So if I am understanding this correctly, If i was going thru ars, which started 2 weeks and 3 days after we were together,,and my rapid test was done 11 days later. In theory by that time the test should have been positive.  As well as the two oraquick swabs.. In my reading I have seen several other posts where people say they tested neg several times with swab tests, but when they did a blood test in a professional setting their tests showed pos. I guess i just wonder how effective the swab tests are when checking for early infection. Still having some symptoms to this day, which is worrysome,  Its been over 3 weeks since this started. I would have thought it would be gone by now. And yes Im in the northeast,,and its flu season. I dont think flu causes rash though..Thanks again for your reply Dr.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Your assessment is correct.  For all of the reasons mentioned in my original reply, I think it is most unlikely that your symptoms are due to HIV.  Missed diagnoses were more common when persons were tested with antibody only tests soon after the onset of symptoms, not at 11+ days as was your situation.  Further, the rash associated with the ARS is generalized, not just localized to areas such as the knew as was your experience.  Clearly you are still worried- as I also said earlier, the way to put these concerns behind you is to get a 4th generation blood test and when it is negative, believe the result and put your concerns behind you. EWH

p.s.  I would be quite wary of rumors that your former GF/recent partner may have been a CSW.

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45 months ago
Hello Dr Hook. Well had to travel a little bit but got a 4th gen rapid test done at 43 days. The test used was Alere Determine hiv 1/2 Ag/Ab combo test. It was a blood draw by finger stick test..Test result was negative as you predicted. Is there any reason to follow up this test with any additional testing, being that even though its 4th gen, it is still a rapid test. Do you feel this is conclusive and no need for a three month test. I really appreciate the help that you provide people like myself by sharing your knowledge.. Thanks again!
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

The Alere 4th generation test is the 1rst rapid format 4th generation test.  Your results are reliable.  I would urge you to believe them and move forward.  I see no reason for further testing

This is my third response to your questions, therefore this thread will be closed in a few hors.  I wish you well.  EWH

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