[Question #2123] HIV and Symptoms

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85 months ago
I am a 30 year old male.  My possible exposure with a female masseuse included: 1. Mutual masturbation. 2. Nude pelvic grinding. She was naked, on top and was grinding at first on my thigh and then moved up to my penis.

I had a non reactive 4th gen AB/Ag at 44 days. Masseuse had non reactive rapid, finger prick screeing test at 32 days and 54 days (I am not sure what generation test she had, at South African public clinic- perhaps you know what they use.)

It is now 62 days since exposure. Since day 3, starting with itching, I have experienced exhibiting rash, cold, tight chest, headache, white tongue, smegma like substance under foreskin, diarrhea, cramps, itchy scalp, dry cough.

I did not not yet attribute these symptoms to HIV as I was under the impression that my acts did not propose any risks, but have since become concerned. Due to not believing any exposure happened I had unprotected one night stand with another woman. I know it was irresponsible - it was a close friend and she is clean. Since then though (26 days) she has shown symptoms of UTI, cramps, diarrhea, cold, dandruff, cold sores. headache.

It is a season change from extreme hot to cold weather here in South Africa.

Please explain: 1- Exposure risk. 2- In detail, early signs of HIV - there is much info on web but it seems to be conflicting as to when specific symptoms show (ie diarrhea after years/within a few weeks. 3- Likelihood of infection given test results of both me and masseuse, my symptoms and other woman's symptoms. 4- If there are symptoms would an HIV test always show reactive, or is it possible to have a non reactive test but still show symptoms.
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Edward W. Hook M.D.
85 months ago
Welcome to our Forum.  I'll first congratulate you on your practice of safe sex and all of the steps (which I might have told you were not necessary) which you to to successfully prove that you did not acquire HIV from the exposure you describe.  I'll also provide my conclusion first, then expand on my comments below.  The conclusion is that your symptoms are not due to HIV from the exposure you have described.

Now for the details:
1.  The activities that you describe all fall into the category of safe sex and have not been associated with risk for HIV.
2.  Your own testing proved that you did not acquire HIV from your encounter.  Recent data now indicate that while nearly all HIV infections are detected using combination HIV antigen/antibody tests, there are a very small proportion of infections which may take longer for tests to become positive but by 6 weeks, all recent infections would have been detected.
3.  I cannot comment on the tests used at the South African public health clinics but they are likely combination tests. - they have become the global standard.  even f they were antibody only tests however, they provide very stron evidence that she was not infected at the time of your encounter. 
4.  So, what about your symptoms?  Indeed they are those of the Acute Retroviral Syndrome (ARS) which can be a sign of recently acquired HIV but they have occurred too late to be due to HIV.  The ARS occurs from about 10 days to 4 weeks after infection, thus your symptoms are too late.  Some of the flu-like symptoms you describe- sore throat, muscle aches and cramps, fever, diarrhea are typical of the ARS but they are also symptoms of an innumerable number of other common, non-HIV viral infections that people regularly encounter.  I suspect that this is what you and perhaps your recent partner may have.
5.  finally, I would add that some of your symptom's- cough in particular are not typical of the ARS.
6.  You do not mention a fever, do you have one?  The reason I ask this is because a fever is quite typical of the ARS.

I hope these answers are helpful to you. Please don't worry about HIV from the encounter that you have described.  There is certainly no reason for additional HIV testing related to the exposure you have mentioned.    EWH
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85 months ago
Thanks for your response. I would like to follow up with a couple of things and ask a couple more questions.

I had other tests syphilis, gonorrhoea, chlamydia, herpes, hep b. All negative too.

My symptoms were actually in the 10 - 4 week window.  Itching and headache actually began after 3 days or so. Other symptoms such as white tongue,  itchy scalp, cough have just persisted to now. 

1. I'm really confused by the symptoms. They are really strange in both me and new partner.  Partner never had dandruff before. My smegma type symptom and rashes (clusters of small spots) are new to me, dairrhea on and off for a month. My doctor advised that I could be creating my own symptoms through paranoia. Could this be the case?  (Although it wouldn't account for partner's symptoms). With regard to symptoms,are there symptoms that are specific to early infection and others that are only present in later stage HIV? 

2. My doctor advised that masseuse's 54 day test would effectively cover about 30 days before our encounter (90 day conclusive test). Even if she was infected within 30 days of our encounter, he said that her levels would not yet be sufficiently high enough to pass infection on to me.  Is this accurate? 

3. Is it possible to have symptoms and test non reactive for HIV, or would symptoms indicate that HIV is ready to be detected in tests? 

4. Please explain in detail how infection in those circumstances is almost not possible. Specifically, if there are cuts on finger during masturbation  (I am a nail biter), and if the vagina came into contact with the tip of the penis during grinding and the female was very 'wet'.

5. Could I pick up other non std virally infections like mono, yeast infection, candidiasis, common flu etc from my encounter that could explain symptoms and how my partner seems to be exhibiting them too?

In answer to your question I haven't displayed fever symptoms apart from the headache, joint aches, weakness and some loss of appetite. I haven't had excessive sweating or shivering. My doctor examined my body and didn't find any issues with lymph nodes. 
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Edward W. Hook M.D.
85 months ago
Thanks for the additional information.  If you had an HIV test since the onset of symptoms and it was negative, then you can be confident of the result.  The ARS symptoms begin at the same time that tests become positive (they are a sign of high levels of HIV antigen and the presence of HIV antibodies).  With respect to your other questions:

1.  Neither dandruff or smegma are symptoms of recent HIV infection.  We do regularly see clients who worry about HIV and in this situation become "hyper-aware", and who note symptoms and findings that are normal but have gone unnoticed in the past.  Itching is probably the most common of such symptoms.

2.  I agree with your doctor and basically told you the same thing above.

3.  No- if you were symptomatic, your test would be positive, see above.

4.  These statements are based on observational research which describe studies of millions of persons.  My statement reflects the recommendations of the CDC and WHO as well as other expert bodies as well.

5.  Could you tell me when your symptoms started , how long they persisted and whether they are still present.  Similarly, how long ago did your partner become symptomatic relative you your encounter outside the relationship?  It would be most unusual for you to still be symptomatic from a viral infection acquired about two months ago. 
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85 months ago
Sorry if I'm being repetitive. I would like to have as much info as possible so as to not keep wondering. Perhaps I didn't pick up on your answers to below but please could you elaborate on:

1. If the masseuse was infected within 30 days of our encounter, are her HIV levels too low to infect me?  At what period since her exposure would her levels become sufficient to pass on infection? 

2. Are cuts such as those from nail biting too insignificant for exposure? Is there too much exposure to air for infection to occur during grinding.  What if her fluid comes into contact with my penis tip?


My symptoms:

Itching - beginning day 4/5. Mostly gone by day 21.
Cold sore - day 5 and day 50.
Diarrhea - day 12, mostly present until day 50.
Headache - day 3, on and off until day 18.
White tongue - day 21 until present. 
Itchy and flaky scalp - day 4 continuously worsening to present.
Lower abdominal pain - day 21 until about day 49.
Red pimples without whitehead - on body since  day 4 to day 21. On face on and off since day 4.
Smegma type flaking - Once at day 29. Again at day 56.
Joint pain - day 10 until about day 50. On and off.
Itching anus - Once at about day 5. Again at day 42.

My partner's:

First, to put into context,she had her period at about day 4. She also hadn't had sex in about 6 weeks. It is also the beginning of 'flu season' here :

Day 1/2 - itching crotch
Day 2 - 6 - extremely painful urination (took medication for UTI and had plenty water etc, didn't really work)
Day 3 - 6 - diarrhea
Day 5 - lower abdominal pain and back pain. 
Day 6 - cold sore.
Day 7 - nausea
Day 12 - bruise looking mark near eye for no reason.
Day 8 - 20 - on and off loss of appetite
Day 27 - cold sore 
Day 30 - flaky scalp (which she never gets)
Present - itchy anus. 
Present - headache.

Do you recommend further testing?
I am happy with all explanations that I am not infected. My major point of concern is that we are both displaying symptoms. 

Could it be something like hepatitis b (which I also tested negative for)

Again, thank you for your patience, and apologies if I missed/repeated anything. 

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Edward W. Hook M.D.
85 months ago
Thanks for the additional information.  Straight to your follow-up questions:

1. If the masseuse was infected within 30 days of our encounter, are her HIV levels too low to infect me?  At what period since her exposure would her levels become sufficient to pass on infection? 

Her negative HIV test is strong evidence that she did not have HIV.  Even if she did however, the activities that you describe did not put you at risk for HIV or any other STI.

2. Are cuts such as those from nail biting too insignificant for exposure? Is there too much exposure to air for infection to occur during grinding.  What if her fluid comes into contact with my penis tip?

Many people have small cuts and skin irregularities which are rubbed and come into contact with partners' genital secretions in the course of mutual masturbation and/or frottage yet there are no proven instances in which HIV has been transmitted in this way.  These fluids are often in contact with the penis tip.  You are not going to be the first person to become infected in this way. 

3. The signs and symptoms that you describe for you and your partner suggest that you have had a shared exposure most probably to some sort of non-STI virus.   The sequence of symptoms, their stuttering course, and their duration are all inconsistent with the ARS or HIV-related symptoms.  It is not clear that this hared illness was related to the exposure you have described. 

4.  I really see no reason for further testing for HIV or any other STI.

5.  Your symptoms are not suggesting of viral hepatitis. 

As you know, our Guidelines provide for up to three replies per question.  This is the 3rd reply to your questions.  I hope they have been helpful.  There will be no further replies as part of this thread and the thread will be closed later today.  Take care.  EWH