[Question #2871] Falling Apart

94 months ago

Dear Doctors,

Thank you for your help and consideration. I am struggling to cope.

9 days ago I had unprotected vagibal and oral sex with a woman in Germany. I do not know her terribly well. I asked her a few times about her testing history and she has tried to reassure me she is clear, but still I am worried.

On occasion she has appeared uncomfortable with the topic and even evasiv which has caused doubts in the truthfulness of her words.

Over the last few days I have had a number of issues. From day 3/4 sore throat, intermittent back pain and most recently (day 7 onwards) a number of oral ulcers. I have counted three in total.

I am so scared that I have contracted the virus and do not know how to carry on living in all honesty. The sex was short and I am circumcised and understand that lowers my risk, but here I am so scared.

I would appreciate your assessment of my situation and also the nature and timing of my symptoms.

Many many thanks

Edward W. Hook M.D.

94 months ago

Welcome to our Forum. I will be glad to comment and hope that my comments will assist you in getting control of your anxieties and regret over the exposure that you mention. The encounter you describe was low risk. You do not provide much detail about your partner but, irrespective of whether she was a commercial sex worker or not, HIV is relatively uncommon in Germany- few women are infected. In addition of the exposures you describe, there is little risk There is no meaningful risk for HIV from receiving oral sex, even if your partner did happen to have infection and the risk of becoming infected from vaginal sex, if your partner was infected, is about 1 infection for every 2000 episodes of unprotected sex. Thus, from a statistical perspective, there is little risk that you were infected.

Similarly, the symptoms that you describe do not suggest recently acquired HIV. Days 3 or 4 are a bit early for HIV-related symptoms to occur and oral ulcers are not a symptom of recently acquired HIV. Further, if you were experiencing symptoms from recently acquired HIV, it would be expected for you to have a high fever as well.

So, in terms of proving that you were not infected- if your symptoms were due to HIV, a combination HIV antigen/antibody (4th generation) test would be positive at his time. To rule out the possibility of having asymptomatically acquired HIV, you will have to wait a bit for testing. At 4 weeks about 99% of combination HIV antigen/antibody tests will be positive and results will be entirely conclusive at 6 weeks after your exposure.

I hope that the facts that I have provided above will help to reassure you. The exposure you describe was quite low risk. If any part of this is unclear, please feel free to ask for clarification- you may ask up to two follow-up questions. EWH

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94 months ago

Thank you doctor. Really helpful.

A bit about her:

She is a 26 yo art student I met 2.5 years ago. We kept in touch and finally hooked up this year. Unfortunately without protection. She told me she tested in August for all things and was clear, but has seemed a little uncooperative at times. This is making it hard to trust her word, although I admit I cannot imagine why she would lie. Our relationship has since deteriorated so she won’t provide any help at this point.

Whilst the sore throat started at day 3, the ulcers only from day 7/8. Is this also too early? Also are you saying ulcers are not indicative irrespective of time passed. I have no other symptoms besides the ulcers, tender lymph nodes and throat discomfort which I must say, feels very peculiar. It’s not all over, just on the right which seems to be around the area behind the back teeth. The nodes feel tender to the touch and are only on the right too.

I had a baseline test last week, a 3rd gen which was negative at day 6 and I am awaiting results from a 4th gen performed the same day. What would these tests tell me?

Lastly what is your prognosis? How hopeful would you, and should I, be? I am circumcised, does this change anything?

Lastly what is your thoughts on taking a PCR DNA test next week?

Thanks

Edward W. Hook M.D.

94 months ago

Thanks for the additional information on your partner. Like you, I see no reason for her not to be truthful and suspect her irritation with you has been caused by your anxiety and perhaps repeated questions about her status. Most people do tell the truth.

Mouth ulcers are NOT a sign of early HIV and, as I mentioned earlier, your sore throat stated early to be a sign of HIV. Further, with a sore throat and mouth ulcers, sore lymph nodes are to be expected. I suggest you stop pressing on your neck, it will just make things more tender..

At 6 days your baseline 3rd generation test means little but, as I also said above, when you 4th generation test is negative as I mentioned, it will prove that your symptoms are not due to HIV.

From all that you say, I doubt that you acquired HIV from this relatively low risk exposure. EWH

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94 months ago

Thank you doctor. Your words mean a lot.

Conscious this is my last Q, I want to make it useful. I hope not to have to return again - of corse for the best - despite the tremendous help you have been.

Accepting your point regarding sore throat, nodes and ulcers, it was a massive help to hear ulcers are not indicative. Once they developed I had pretty much seen my fate as over and given up. It’s good to know I have a reason to keep faith.

My sore throat has been since day 3/4, but has definitely changed in the last day (day 8). It went from a dull ache all over to a more painful section only. Just the right hand side and quite low. Does this change your assessment? I feel it only when I swallow.

Is 8 day still generally early for a sore throat for ARS? Additionally if it were ARS, would there need to be other symptoms? Fever, rash etc?

I am glad you after regarding her propensity to have lied. It wouldn’t make much sense as she said it both when we were fine and not fine. I o joe imagine if she were to lie, it would be in only one instance, so works at some point said otherwise. Also I only really pressed her about all tests, so she could easily have copped out by saying she only tested for certain things and she did not. If she did test she couldn’t have it and not know as she said she hadn’t had unprotected sex since. This is all so stressful.

I hope firstly that the duo is negative next week, then will try to wait. What are your thoughts on the pcr test should I become desperate?

Lastly, o know you are not psychic, but what are your thoughts on my situation?

Edward W. Hook M.D.

94 months ago

Your follow-up questions are, at least in part, a bit repetitive. I urge you to get control of your anxiety. It is not warranted.

I am afraid you are continuing to be overly anxious. It is typical of any, 'every day" sore throat to progress in the manner you describe. The ARS most typically BEGINS about a week after exposure. Further, the symptoms of the ARS are far more than a sore throat and include high fever, sever muscle and/or joint aches and, on some occasions, a generalized skin rash or diarrhea. As I have already told you, your illness really does not sound like the ARS.

As far as the PCR test is concerned, I consider it a waste of time and money. It is little better than the 4th generation tests for most patients, tends to be expensive, and has a higher false positive rate than 4th generation tests. I almost never recommend it and do not recommend it for you.

Your risks of having acquired HIV are very low, certainly less than 1 in 100,000. Try to worry.

Finally, please no repetitive follow-up questions. My answers are not going to change. Be confident that your risk for HIV is very, very low. Take care. EWH

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94 months ago

To add doctor.

Would any of the above be different if it was canker sore I had? I had another look and think it might be in that there looks like puss within?

Thanks

94 months ago

Sorry I added the above before it refreshed with your latest comments. I appreciate your remarks and Will yry to control my anxiety.

Does the above change anything if it is a canker rather than an ulcer? Thank you

Edward W. Hook M.D.

94 months ago

Final remarks, after which the thread will be closed. No, the presence of a canker sore rather than some other sort of oral ulcer in no way changes my assessment or advice. Take care. EWH
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