[Question #3263] Another Unprotected Oral Sex Question

39 months ago

December 29th: Received brief unprotected oral sex (blowjob) from massage lady. It was less than 5 seconds, very brief exposure.

2 Days After exposure: Itchy rash side of neck and upper chest.

4 Days After exposure: Went to urgent care for rash and diagnosed with contact dermatitis. Got steroid shot for the rash.

7 Days After exposure: Fever (high grade), chills, one minor tongue ulcer, headache when looking down, cough, runny nose, green phlegm from mouth and fatigue. Felt like staying in bed all day long.

8 Days After exposure: same symptoms as listed in the above line.

9 Days after exposure: Low grade fever, loose stool (diarrhea), nagging cough got worse with more green phlegm, chills continued but started feeling better.

10 Days after exposure: Felt much better but still low-grade fever. Chills went away. However, the nagging cough was still there with green phlegm. Doctor said it’s common cold and gave me OTC to loosen the mucus. No need for chest X-rays.

11 to 15 days after exposure: Felt normal but cough was still there. No green phlegm but overall coughing. I did get one more tongue ulcer after 15 days. I must admit I was over stressing with ARS thoughts that must have triggered ulcer on the tongue.

21 days after exposure: Bought Oralquick at home oral swap HIV test from Walgreens and tested negative.

As of this writing (26 days post exposure), I’m still coughing little bit especially after sipping glass of wine.

Questions:

1)      These symptoms sound like ARS at all?

2)      How accurate is at home OraQuick oral swap test at 21 days? I’ve read on your medhelp posts that HIV test would be positive 1 week after ARS symptoms.

3)      Is there any need for future HIV tests?

Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Welcome to the Forum.  I will be happy to answer your questions.  You should not worry about having acquired HIV from receipt of oral sex, no matter who your partner was.  There has never been a case of HIV proven to have been acquired from receipt of oral sex and you are not going to be the first.  In addition, your symptoms do not suggest the ARS of HIV.  Your symptoms began too soon after contact and recently acquired HIV does not cause runny nose or cough.  I agree with your doctor.  As for your specific questions:

1.  No,  The symptoms of the ARS typically start at about the same time and are principally a sore throat, muscle or joint aches and a high fever.  As noted above, these sorts of symptoms in the presence of cough or runny nose do not suggest the ARS.
2.  An Oraquick taken at 21 days is too early to provide reliable test results and would detect less than 50% of recent HIV infections.
3.  There is no need for further HIV testing related to the exposure you have reported and your recent symptoms

I hope that these comments are helpful.  EWH
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39 months ago
Yes, they were indeed helpful and I've put this fear of HIV on the side for good.

Last follow up question. So, yesterday morning after the bowel movement I've noticed white milky/cloudy drop of semen or exact semen type discharge. It was outside the tip of my penis exactly after the bowl movement. No pain, no discomfort at all. I wouldn't have noticed the discharge at all. I immediately thought about STD but it was too late for it to appear after the exposure (almost 1 month). So, I called my friend who just finished his residency and he told me it's probably prostate fluid not STD. It probably made sense because I went into abstain stage for last 72 hours, no self pleasing either. 

I had another bowel movement this morning but I didn't see any discharge today so it gave me sign of relief. Do you agree about prostate fluid assessment?

I've been a long follower of you and Dr. HHH from Medhelp era. I thought I lost you guys when the Medhelp stopped accepting expert questions on HIV prevention site. But, I'm sure glad to find this site. It doesn't mean I'll ask repeat anxiety driven questions but just glad to see you and Dr. HHH here.
39 months ago
Sorry, I forgot to ask this in the last follow up. Let's say, if I were to put myself into any future situation where I engage in somewhat low risk activity. Then, would it be safe to test for HIV using at home OraQuick oral swap test exactly 8 weeks post exposure? I understand blood test are more accurate but I just get peace of mind doing the testing at my own home.
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Thanks for your thanks.  I know I speak for both of us when I say that we are glad we can work with ASHA to be helpful.

Regarding your question, indeed, I would assume that the fluid you saw was prostate-related fluid.  The pressure within the abdomen when taking a bowel movement, as well as the movement of stool out of the bowels can sometimes express fluid of the sort you describe. 

The home HIV tests have been carefully studied and are highly reliable.  Thus if you follow the instructions as indicated, you should have confidence in the results.  Be sure to read the test at the specified time as when time has passed beyond the recommended period the tests can appear positive when they are not.  If, after a home test, you have further questions, then go to the lab and get a lab-based test.  EWH
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39 months ago
Thanks. Yes, I've read on the instructions that we have to read the oraquick results between 20 to 40 minutes after taking the swab else it won't be accurate. My question was more like whether 8 weeks post exposure...oraquick oral swap test be 100% accurate? Not related to this incident but just for future reference. I know I could put myself at risk in the future so I was wondering whether 8 weeks post exposure of at home oraquick is 100% accurate?

Also, you can close this thread. Thank you for your continuous support here. I just get warm fuzzy feeling when the answer comes either from your or Dr. HHH as opposed to my primary care physician or any other online expert. 

I know I need to change that mindset:)
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
 The results of the OraQuick tests are nearly conclusive at eight weeks following exposure and absolutely conclusive after 12 weeks.   Combination HIV antigen antibody tests are certainly more reliable and give conclusive results at seven weeks following exposure but for some persons, and perhaps yourself, the convenience of being able to test at home is important. 

 As you know because this is my third response this will complete this thread which will be closed in a few hours. Take care. EWH
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