[Question #3236] Unprotected Cunnilingus with possible STI Presence - HIV Risk?

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91 months ago

Day 1 - Australia

I am male, had passionate unprotected cunnilingus - 5-10 minutes on a female sex worker, may have ingested some vaginal fluid. gums are healthy, vagina didn't have any blood. note: she claims she doesn't have hiv/STIs, and was tested several days before.

Day 2 to Day 10

symptoms include fever, muscle aches, coughs, stuffy nose, fatigue

Day 11

Blood test came back, HIV negative on 4th gen machine

Day 12

Tested +ve for chlamydia - treated with zithromax 

Day 13 (current): 1. Body temp normal-slightly high, 2.Fleeting pain - comes and goes can be minutes or hours between each event. can be in jaw, arms, thighs, groin, hand, neck, head (most worried about this) 3.tonsils are slightly swollen, w/ slight sore throat, zero pain on swallowing but have uneasy feeling, sometimes lumpy in throat (comes/goes) 4.stuffy nose past 5 days but is slowly starting to clear , 5.pronounced little dark black marks appeared on upper back/arm, 6.fatigue has reduced

Question:1.What is my risk exposure level given the above encounter? 2. What % confidence does the hiv test give? 3. As of Day 13 Given the fact that I am currently under stress/anxiety, what are the causes of my current symptoms? Is it due to flu/anxiety/other? 4. Given the detection of chlamydia on day 12, does this suggest I caught chlamydia before encounter & if so, how does that affect the hiv transmission probability? 5. I am most concerned about the persistent muscle/body aches, any possible explanation?

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Edward W. Hook M.D.
91 months ago

Thank you for your questions. I will do my best to try to help. In some instances, additional information from you may be helpful.

 

Question:1.What is my risk exposure level given the above encounter?

This was a low risk encounter.  Licensed commercial sex workers in Australia are required to get regular STI (including HIV) check-ups and infections in this group are unusual.  Further, cunnilingus is a low risk sexual activity which is not “efficient” for acquisition of STIs, even if your partner was infected.

 

2. What % confidence does the hiv test give?

A combination HIV antigen/antibody test at 10 days will not detect many recent infections, probably in the neighborhood of 40-50%.  At 4 weeks the combination tests will detect about 99% of recent infections and at 6 weeks (42-45 days) their results are definitive.  HIV PCR-type tests provide reliable answers earlier (12-21 days) but are more expensive and have more false positive test results.

 

 

3. As of Day 13 Given the fact that I am currently under stress/anxiety, what are the causes of my current symptoms? Is it due to flu/anxiety/other?

Given your description and the nature of the exposure you describe, your current symptoms are more compatible with a recently acquired, non-STI/non-HIV viral infection than HIV.  Cough and a runny nose are not part of the presentation of a recently acquired HIV infection.

 

4. Given the detection of chlamydia on day 12, does this suggest I caught chlamydia before encounter & if so, how does that affect the hiv transmission probability?

Was this a genital infection?  If you only performed oral sex on your CSW partner, then your chlamydia infection was likely acquired from a different partner.

 

5. I am most concerned about the persistent muscle/body aches, any possible explanation?

Please see comment 2 above.

 

I hope this information is helpful.  If any of this is unclear or you have additional questions, please feel free to use your up to two follow-up questions.  EWH


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91 months ago
Thank you Doctor edward for your detailed and well constructed reply.

You mentioned you wanted additional info. Please let me know if your require further information beyond the below.

Point 4
It was via a throat swab, so does that indicate a throat Chlamydia infection? And what is the nuance/difference/implication between a throat or genital infection?

And in terms of the activity, there was only protected fellatio in addition to the unprotected cunnilingus. Apologies doctor was not able to mention this due to initial word count restriction.

Point 5. I will also add that on Day 13 my elbow has grown a small lump that looks like a sac and there is also a raised black bumplike pimple in my pubic region. This is additional disconcerting and I am willing to email you the photos for review if it is something you can do.

I also have some points to clarify, hopefully it is not at the expense of another question. If it is not i am much relieved, grateful and appreciated. 

Point  1
You talk about this in a general STI way but can you please clarify your answer in specific to HIV in this encounter? To tell you the truth, it really is HIV I am concerned about. E.g. Is it in your vast experience that the hiv risk here is something very low and you've never seen before? 

Point 5
For this post you refer directly to point 2, with no further explanation or any other possible illness possibilities . Was this done as a subtle hint that you believe that particular symptom, muscle/body ache could have something to do with an ARS infection? Would be grateful to hear your thoughts patterns behind this comment as it would be the one symptom I am most anxious about cant seem to recover from.

The other reason why I am bringing it up is that I think I read somewhere that you  or another doctor on med help mentioned a comment that body aches are not a symptom of ARS, so if possible please let me know your thoughts around that as well.

Thank you so much again, look forward toy your reply.


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91 months ago
P.s. apologies just to add to that last point 5. Does the fact that the muscle and body aches come and go instead of being constant make a difference at all at this point? Thanks 
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Edward W. Hook M.D.
91 months ago
I will try to answer in the order you asked your questions:

Point 4.  Pharyngeal chlamydial infections are quite rare but do occur.  It is conceivable that you acquired your throat infection from performing oral sex on your CSW partner.  You should be treated for this positive test.

Point 5.  We do not look at pictures on this forum.  What you describe, "a raised black bumplike pimple" does not bring to mind any STI.  I suggest you ask a trained clinician to take a look.

Point 1.  There are no proven instances in which HIV has been proven to be acquired as the result of cunnilingus.  I have never heard or seen anyone who acquired HIV in this way.

Point 5.  Sorry, I should have referred you to point 3, not point 2.  Irrespective your cough, runny nose and body aches are more compatible with a non-STI/non-HIV flu-like viral infection than HIV.  As to what it might be, we cannot make diagnoses over the internet and do not try to. There are some unusual aspects to your description (your rash for instance) for which it would be better for you to seek the assessment of a clinician who can directly examine you.    As i said, cough and runny nose are NOT characteristic of recently acquired HIV.  OTOH, high fever, sore throat and muscle and joint aches are typical of recently acquired HIV. 

I hope these clarifications are helpful.  EWH

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91 months ago
Thank you Doctor. I do have follow up questions so will get back to you as soon as possible 
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91 months ago
Point 4.
Is there any increased HIV risk posed if either myself or the female has chlamydia or an STI during the encounter? Does it increase the likelihood of transmission of HIV? 

Point 5.
I do have questions regarding typical ARS symptoms, if you can please assist in any way that'll be grateful.

You mention that typical ARS symptoms are high fever, sore throat and muscle/joint aches. Will they all come at once? Do they last for hours or days?

Can you please describe to me please the temperature range of the high fever? With the sore throat will it be so painful everytime you swallow or breathe? 

I also noticed that you used the words body aches and muscle aches as two separate things. I am still not clear how the two are different. Can you please elaborate on this further so I know how to identify them? In your experience if someone did get muscle/joint aches as part of the ARS, is it always severe and across the entire body and is the pain constant or fleeting? And does it last for days or minutes?

In other forums you also mention rash as another typical symptom. If so, is it isolated to a single part of the body or is it everywhere? What will it look/feel like?

Point 6.
I have just administered another 4th gen HIV test on day 17, if this is negative how conclusive would if be that I do not have HIV?

Point 7.
Also finally, I know you don't try to diagnose but I am concerned, can you please review quickly if any if the below symptoms are indicative of ARS?

Would it be typical to start experiencing ARS symptoms as early as day 17 or do they come later?

Day 15.
On day 15, for some reason my body went through a period of serious lethargy and non energy for about 12 hours, then subsided. 

Day 16.
-Feeling a little lethargic, not as bad as day 15.
-Tender spots at chest area, close to the shoulders
-Throat has a coming and going throbbing pain
-No sore throat
-Shooting pain in jaw
-Weird sensation in right upper arm and right lower leg
-Small zap feeling in right hand
-Low libido
-Drop in appetite (but still eating)

Day 17. 
- no fever, currently 36.9 degrees temp
-no rash
-muscle/body aches, comes and goes
-Body tingling comes and goes
-Sometimes my joints get a funny feeling.
-throat is always uneasy, itchy feeling
-upper chest mucles still tender throughout the day 

Thanks for your time Dr. Edward, really appreciate it.
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Edward W. Hook M.D.
91 months ago
These questions are repetitive and appear to ignore that assessment that has already been provided.  Repeating the question will not change the answers.  Straight to your questions in the order you used:

Point 4.  As I already told you, there are no proven cases of HIV acquired through perfromance of cunnilingus on an infected person.  I suspect some of those people who had cunnilingus performed on them has chlamydia, gonorrhea or other STIs yet there were no transmission.  You need to stop worrying.

Point 5.  The symptoms of the ARS tend to occur at about the same time and typically list a few (3-5 days), just like the flu.  The temperature would typically be over 102 degrees and the sore throat can be severe but not so severe that you could not swallow or breathe. 

Body aches and muscle aches are similar and different people refer to the same sensations using different words.  and yes, the ARS symptoms of muscle/joint aches tend to involve many or even most joints. 

The rash of the ARS tends to be generalized.  Less than half of people with the ARS have a rash.

Point 7.  A negative 4th generation test would prove that any symptoms present at the time of the test were not due to HIV but the tests do not become more than 99% reliable until about 4 weeks after exposure.  They are completely reliable at 6 weeks.

The ARS could start around day 17 but none of the symptoms you describe suggest the ARS at all.

This is my 3rd response to your questions.  As per Forum guideline, this thread will be closed shortly.  Before I do, let me once again tell you that you are worrying entirely too much and that your risk for HIV form the events you describe are essentially zero.  You need to stop worrying and move forward without concern.  Further anxiety-driven, repetitive, atttempts to start a new thread may lead to the thread being closed without an answer.  Take care.  EWH
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