[Question #1984] I have all the symptoms of HziV

49 months ago
Dear 
            Doctor.

I'm a gay male who had a sexual encounter with a sexually active gay man I met online, three weeks ago.

I masturbated him until he ejaculated in my hand. He briefly put his mouth around my penis and sucked on it for no longer than a minute.

After he ejaculated he used an outdoor cover of some sort to wipe his penis with, I too used this cover to wipe off his saliva from my penis. It's possible that his semen could have entered my penis.

Two days after this encounter I felt very ill, I came down with a fever and had nightsweats.

I visited my doctor two days later and she tested me for chylamdia and Gonorrea, my tests came back negative.

By the third day after exposure my symptoms worsened and I developed a rash all over my body and I had swollen lymph nodes and a sore throat.  My fever got worse and I had headaches and night sweats.

I visted my doctor again, five days after the possible exposure and she assurred me that I don't have HIV.                            

However my symptoms say otherwise. They lessened for a few days and then came back again.

Q1.Do you think I acquired HIV from my described encounter?

Q2. Is it possible to show Ars symptoms 3-4 days after exposure as I have and then have have them flare up a week or so later?

Q3. Could I have acquired syphilis and do my symptoms suggest I have?

Thank you for your time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome to the forum. Thanks for your question.

This was a zero risk sexual exposure, even if your partner has HIV. (Congratulations for having only safe sex!) And two days is much too soon; new HIV symptoms (acute retroviral syndrome, ARS) don't start for at least 7 and usually 10-14 days after catching the virus. And although some of your symptoms are consistent with ARS, they also go along with any number of other medical problems, including minor viral infections, which are much more common than ARS. Most likely you caught a garden variety respiratory virus, or perhaps even strep throat (either of which can be associated with skin rash). Finally, ARS symptoms do not come and go like yours. Once they start, usually they continue unabated for a couple of weeks. For those reasons, I agree with your doctor.

Those comments directly address questions 1 and 2. As for syphilis, there is slight risk from the exposure described, but only slight; the large majority of syphilis in men who have sex with men follow anal or oral sex, not the brief and fleeting sorts of contact you describe. Syphilis can cause skin rash, but not sooner than 6 weeks (usually 2-4 months) after catching it.

My advice is for you to have blood tests for syphilis and HIV. This does not mean I really think you have either one; for the reasons above, I am sure you don't. However, when people are concerned as you are, negative testing is often more reassuring than professional advice, no matter how expert. You can have a conclusive 4th generation (antigen-antibody) HIV blood test in a week, i.e. any time 4 weeks or more after exposure. Syphilis blood testing also would be highly reassuring at that time, although not truly conclusive until about 6 weeks. In the meantime, stay mellow. You can be very confident you do not have either HIV or syphilis.

My last comment is to note that you don't mention your partner's HIV status. In the future, you should plan on never having sex with other men without first discussing your mutual HIV status. Most MSM expect it, most have been tested, and most don't lie about HIV status when asked directly. And avoid sex with those who are positive (and not on treatment), don't know, or seem evasive. Even intended safe sex sometimes gets out of hand -- but at least in that situation you can be especially careful about it.

But I stress once again you were not at risk and do not have either HIV or syphilis. I hope this information is helpful. Best wishes and stay safe--

HHH, MD

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49 months ago
Thank for quick and helpful response Doctor. It gives me some comfort.

I'm still concerned however.

Apologies for leaving these points out of my post. 

I had a wart and still do on the hand that I masturbated the man I was with.

When he performed oral on me it was very quick and unexpectant, he was rough. I don't believe he bit me it's possible.

My symptoms persist, they include a rash all over my body, sore throat, swollen lymph nodes, headaches and nightsweats. 

Apologies but have you anything to say about the above?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
No need to apologize for anything. These are reasonable follow-up questions.

Warts on the hands (or genitals) do not significantly increase the risk of HIV or any other STD. And there are no data to suggest that rougher oral sex is any more unsafe than less vigorous exposure. You would have noticed the injury if there had been a bite sufficiently severe to risk HIV; there would have to be an obviously open, bleeding wound.

I understand your concern about your symptoms, and of course nobody can say there is zero risk of HIV from oral sex. However, there has newer been a proved case of HIV transmission mouth to penis. And certainly not by skin contact with semen. But given these symptoms, it would be reasonable to return to your doctor and ask her again about her judgment about acute HIV, and perhaps test for it. If that were the cause of your symptoms, testing would now be positive, without a need to wait until the 4 week mark. Or if not your own doctor, an expert in infectious diseases and/or HIV and other STDs. HIV blood tests are always positive within ~10 days of onset of symptoms.) Don't get me wrong; I'm still confident you don't have HIV. But you deserve the reassurance of knowing for sure. 

Alternatively, contact your partner if you can, and ask about hsi HIV status; and if not recently tested for HIV, ask him to be tested. If somehow he infected you, his test would have to be positive.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Three other thoughts for you. First, you don't mention previous sexual encounters. Have you had any in the 3-4 weeks before the one described above (including regular partners)? Second, did your doctor mention mononucleosis and/or were you tested for it? Third, have you taken any new medications in the past few weeks, especially ampicillin, amoxicillin, Augmentin, or other antibiotics? These could explain symptoms like yours. I stress again that symptom onset was much too soon to be HIV (or mono) from the exposure described above.

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49 months ago
Again thank you for your help.

That encounter was my first and only form of sexual contact that I've had in life.

I am not familar with "Mononucleosis", my Doctor did not mention that to me as a possibility. So no I wasn't tested for it.

Upon giving my urine sample to my doctor. I was given an injection for Chylamdia and Gonorrea, I don't know the name of the drug used.

I was also prescribed with 4 250mg tablets of Azithromycin, two days after exposure. I believed this gave me diarrhoea.

My Doctor also prescribed a type of amoxicillin to me five days after the encounter as I was complaining about the Swollen Lymph nodes.I stoped  taking these after two days as I thought it was possible that they were making my rash worse, that's unlikely  now given that my rash has persisted.

I have a question for you relating to the 4th generation blood tests

Would the test be a rapid blood test or would I have to wait for the results? And what's the difference?

My Doctor told me she didn't want me tested for HIV until four months after my possible exposure.

Thank you again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Thanks for the additional information.

I'm surprised you haven't heard of infectious mononucleosis. Google it for lots of readily available information. (If you're in the UK or certain other countries, mono is often called glandular fever; same thing.) The amoxicillin business may be doubly significant:  mono cause symptoms like yours and also greatly increase the chance of a skin rash in people taking amoxicillin at the same time. And the rash can last 2-3 weeks after stopping the drug. So this sounds like a definitely possible scenario. A quick test widely available is called Monospot┬«; if necessary, tests also can be done for Epstein Barr virus, the usual cause of mono. Some cases of mono are not caused by EBV and these tests would be negative; but a positive monospot would confirm that diagnosis.

The shot was ceftriaxone (Rocephin) for gonorrhea; the azithromycin was to cover chlamydia. Although there is risk of gonorrhea by oral sex, chlamydia is almost never transmitted mouth to penis. But azithro is routinely given with ceftriaxone, so this isn't necessarily a criticism of your doctor. However, either you misunderstood her about the timing of HIV testing, or she is dead wrong:  the 4th generation (antigen-antibody) HIV blood tests, now routinely used, are conclusive at 4 weeks; and even the older (antibody only) tests are conclusive by 6 weeks. Testing at 3 months once was common advice, but that was for older antibody tests no longer widely used. It is never necessary to wait 4 months for conclusive results (and never was).

Do not have the rapid oral fluids test, which is inherently less reliable than blood tests and tends to take longer for conclusive results. The rapid blood tests are pretty good, but most are antibody-only tests and hence not conclusive until 6 weeks. Best to have a laboratory based, non-rapid 4th generation test at 4 weeks.

And by the way, having had ceftriaxone, azithromycin, and amoxicillin, it is impossible you have syphilis. You probably weren't exposed, but if you were, you were cured before it ever caused a problem. So there is no need for the 6 week syphilis blood test I suggested above.

We try to avoid criticizing users' personal physicians. However, there is evidence your doctor might not be fully up to speed on HIV, STDs, and mononucleosis. You might seek out (or ask for referral to) an infectious diseases specialist. If you're in the UK, an NHS GUM clinic would be an excellent option.

Normally threads are closed after two follow-up questions and replies, and we're there. However, I'll leave this open so you can tell me the results of your HIV test, and a test for mono if you have one. However, I'll have no more comments or advice until then -- so let's wait until you have test results to report. OK?

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48 months ago
Hello Doctor again.

I took your advice a got tested for Mono and Strep throat, both of which came back negative.

I then went to an STD clinic in a private hospital in Ireland.

I was tested exactly 30 days post exposure, for the following, results included.

Chylamdia/Gonorrhea-Negative.
Hep, B and C-Negative.
Syphilis -Negative.
Rapid HIV blood-Negative.
4th Generation lab test-Negative.

The clinic didn't offer herpes testing.

I'm going to get tested at another clinic that offers herpes testing.
I still believe I acquired and STD (possibly herpes). My Penis is inflamed at the uretha and the head of my penis(circumcribed), the inflamation is serve and quite painfull.

My other symptoms have mostly gone, including the rash. Still have light fever, sore throat and believe I'm coming down with a chest infection.

Questions.

Q1.Am I in the clear of HIV? When would I be 100% clear after testing?

Q2. Am I in the clear of Hep B, C? Was I tested too soon.

Q.3Am I in the clear of Gonorrhea and Chylamdia.

Q4. You mentioned that Syphilis testing wouldn't be conclusive until six weeks, so I assume I can be tested for that conclusively
at this stage.

Q5. I believe I have acquired Herpes, what are your thoughts?

Q6. I read online that if a Co-infection of HIV and Syphilis occurs the stages of syphilis don't follow the typical pattern. Meaning a person can have secondary stage syphilis early? 
Is the above true or false?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Q1) Definitely in the clear. The kind of test you had is conclusive any time more than 4 weeks after exposure.
Q2) As for HIV, this exposure carried little or no risk for hep B, and absolutely none for hep C. In any case, your test results are conclusive.
Q3) Also conclusive, as well as being very low risk from the exposure described.
Q4) Alsoconclusive.
Q5) Your symptoms are not remotely suggestive of herpes. I recommend against testing for it. If positive, it would not be from this event.
Q6) It is true that HIV can alter the clinical course of syphilis and development of typical stages. However, we know for sure you don't have HIV, so it's irrelevant. In any case, this problem has no effect on the reliability of syphilis blood tests.

That concludes this thread. You can move on without worry. Please do not be tempted to post a new question about this exposure, risks, and test results. The answers will not change and repetative questions are not permitted.

Best wishes and stay safe. 
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