[Question #2016] HIV Symptoms from Receptive Oral Sex

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86 months ago
Hello Drs. Handsfield and Hook:

Thank you for providing this valuable and informative service. I always heed your advice about discussing HIV/STI status with all of my partners before we do anything and I always practice condom protected intercourse in the rare instance intercourse is involved. My concern is as follows:

About 10 days ago, I met up with another man and of course asked him his status (before the meeting and during). He told me he's negative and I began to perform oral sex on him but realized that something was off when he started drinking alcohol. After a few minutes, I was uncomfortable proceeding with oral sex and ended the encounter. There was no ejaculation and as far as I can tell no pre-cum either.  Last night I came down with a low grade fever (99.5) that went away after I took ibuprofen. This morning I woke up with a sore throat and a feverish feeling. After taking ibuprofen again, the fever went down for several hours, but came back an hour ago.

Even though I understand the risk is lower for oral versus intercourse, I am worried that I am experiencing symptoms of ARS.  The timing and symptoms are peculiar to me. What is your thought?

In addition, I have been considering taking PrEP to augment my safe sex practices but have not seen much about it discussed on your forums. My new doctor is LGBT friendly and offered it at my physical a month ago and I haven't had a chance to go back to discuss with him. If my symptoms aren't indicative of ARS, would you recommend PrEP or at least have any pros-cons to consider after I get tested?

Thank you so much for your time and wisdom.
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Edward W. Hook M.D.
86 months ago
Welcome to our forum and thanks for your confidence in our advice.  While I can understand your concerns, the odds that your symptoms represent the ARS are tiny.  While the timing go your flu-like illness is about right for the ARS, this is typically a more severe illness than you report with severe muscle aches and joint pains accompanying the fever and sore throat.  In addition, you partner said he was not infected and did not ejaculate.  Even if he had HIV, your risk for infection would statistically be less than 1 in 10,000.  It is far more likely that you have coincidentally caught one of the non-STI viruses that we all get from time to time.  None of that however is absolute and I would consider testing with a 4th generation combination test, just for the peace of mind I suspect it will provide.  I am confident the test will be negative.

Once HIV has been ruled out, I would suggest you discuss PrEP with your doctor.  While you are doing everything right, PrEP would provide yet another layer of protection and is typically well tolerated.

I hope these suggestions are helpful.  Please don't hesitate to follow-up if there are further questions or something I suggest is unclear.  EWH