[Question #3088] Worried Ars questions

38 months ago
Hi Dr. About a month ago I met a higher end csw and had unprotected oral both receiving and giving.  Also protected anal sex.  The condom was in tact and nothing slipped or ripped.  Since then I haven't felt great. Strange burning sensations in arms and legs that is more prominent at night. My throat feels a little strange but nothing approaching a severe sore throat. No fever at all. No rash and don't think my lymph nodes are swollen. Do you think I should be worried about hiv?  How long does those typical ars symptoms last?
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to the Forum.  I'll be glad to comment.  The exposures you describe are close to no risk for acquisition of HIV and other STIs and are mostly likely coincidental to the events you describe.  There are multiple reasons why, when I put them together, I say this with great confidence.  Listing them on no particular order:

1.  MOST CSWs and particularly higher end ones do not have STIs. CSWs are aware of their risks and are better at protecting themselves (i.e. they have lower condom failure rates and check themselves frequently).
2.  If infected, even most unprotected exposures do not lead to infection.  For HIV, if a partner was infected (unlikely) the likelihood of acquiring HIV from insertive rectal intercourse is estimated at one infection per 1000 exposures, for performing oral sex on an infected man (far less for cunnilingus) the estimate is 1 infection in 10,000 exposures, and there has never been a case of HIV proven to be transmitted through receipt of oral sex from an infected person. 
3.  Condoms which are worn throughout sex are estimated to reduce risk for infection more than 99.9%.
4.  When the ARS occurs, fever is almost always a part of it.  OTOH, burning sensations of the sort you describe are not- your symptoms in no way suggest the ARS.  They are the sorts of symptoms we see with anxiety.

Thus for all of these reasons I would not worry about HIV (or for that matter, other STIs from the exposures you describe.  I have no objection to you getting tested if it would make you feel better.  At his time you could test for HIV and other STIs.  Testing for HIV would detect over 99% of recent (i.e. in the past month) HIV infections while testing for more common STIs like gonorrhea and chlamydial infection would be conclusive.  I hope this information is helpful to you.  EWH
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38 months ago
Thank you Dr.   This is reassuring.  Have a nice holiday season. 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
I'm pleased I could be helpful.  EWH
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