[Question #342] Desperately scared

35 months ago

Dear Doctor,

I am very concerned now over this incident. On November 24th I was at the mall and I had a fresh cut on my lip from biting (nervous habit) and peeling my lips in the cold weather. I went to the bathroom to try to stop this bleeding with a tissue and I think water. I then walked out with it exposed and I am sure the bleeding was still active. This is the most unlucky thing ever but this is exactly what happened. As I was walking out a man, who was either mixed race or African American (just so you know background) pretty close to me let out an enormous sneeze without covering his mouth at all (I mean enormous) and the secretions went right onto me including on my mouth. I saw a significant bit of white clear stuff on my mouth which I went to wash off right after. I was in a daze so I don’t know how well I did this. Two days later I started with fatigue and mouth ulcers, including a mouth ulcer under my tongue. The symptoms only got worse and I have Never been so tired . Muscle aches, especially legs just general weak not leaving bed for the duration of at least ten days. Having to Force myself to do anything.  I have had shooting pains in legs, hands and arms. Loss of appetite and also now weight. Then sore throat started after two weeks from the incident. Burning sore throat and chest. Extremely severe. This has been the sorest throat I have ever known. My fatigue is improving but I am still sick. Also Intermittent nausea. Insomnia. A very stiff neck and some pain in one side in my ribs. I have had some white stuff on my tongue, which has also felt irritated, and for a day or so had a small blood spot on the floor of my mouth. My stool is also not normal, but pellet like. There has been no fever (possibly low grade though) and no rash.  I have had CBC done which came back normal. How likely was it I contracted hiv? Does it enhance the risk that I went to the bathroom and possibly wet the cut just before etc? I have really never been this ill and all I want to do now is cry. I was sick enough to go to the doctors four times during this and none of them could diagnose an illness – just something viral and red throat. I have felt so incredibly weak. I am worried and sad because I have kids etc in mind for my future. Of course, I will be tested but I am very depressed now.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your question.

I understand your concerns; what you are experiencing is obviously frightening. However, you really needn't worry. Nobody in the world has ever been known to acquire HIV from an exposure like this. In the world's busiest HIV/AIDS clinics, there never are patients who didn't have the standard, known risk factors:  unprotected sex with a partner at risk, shared drug injection equipment, and so on. None, no exceptions. That alone tells you that the virus cannot be transmitted except by such exposures.

Also, sneezing and coughing simply does not transmit the virus, which rarely is present in oral fluids. In fact, saliva kills HIV. Even biting rarely transmits it. So even if the person who coughed on you had HIV, you were not at risk foe catching it.

Finally, your symptoms are not typcial for a new HIV infection.  HIV generally causes mild sore throat, not severe ones, and is an uncommon cause of most of the other symptoms you mention. Also, they started too soon after the coughing incident:  HIV symptoms cannot start sooner than 8-10 days after catching the virus. Almost certainly you have had a garden variety upper respiratory virus or influenza, which has hung on a bit longer than normal but otherwise doesn't sound serious. On top of that, you have seen 4 different doctors who reassured you.

So you are on exactly the right track in your plan to have an HIV test. Do not hesitate further because you fear the outcome. You know very well how silly that is. It isn't the test that gives someone HIV. You have it or you don't -- almost certainly not, and you can expect a negative result. Anyway, when people delay testing for serious conditions and finally do it, stress always declines, even if the feared outcome is realized: fear and anxiety over the result actually are more stressful than getting an answer. And for all the reasons discussed, you for sure can expect a negative HIV test result anyway.

Per forum policy, your posting fee entitles you to two follow-up questions or comments with replies, so let me know if anything isn't clear. However, I would suggest you save at least one of those follow-ups until you have been tested and know the results. I would be very happy to have an opportunity to reassure you once more after you have had the negative test results. In the meantime, do your best to stay mellow and put aside your fears. There really is no chance you have HIV, assuming you haven't otherwise been exposed.

Best wishes and happy holidays---   HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
I forgot to say something about test timing. The coughing event (avoiding the word "exposure") was 3 weeks ago. At this time, an HIV "4th generation" or "duo" blood test will be around 90% reliable, i.e. a negative result will be very reassuring. However, you'll have to wait until 4 weeks to have a conclusive result. If my comments above convince you there is no real risk, you may decide to wait until then. But if you can't stand the stress of waiting, which I would understand, have a test now and another one in a week.

Do not have a rapid oral fluids self test at home. That test takes longest of all to become positive and is not conclusive until 3 months. You need a lab-based blood test. Ideally, you should return to one of your four doctors, or an HIV/AIDS expert, then follow their guidance on testing details.

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34 months ago
Thank you for your response Doctor. You explained things very clearly. I do understand this rationally, however it does not make sense to me that I would have become so severely ill from a flu. That has never happened before apart from once when I had a very serious case of thrush, different symptoms of course. The burning in my throat and chest did start after two weeks of the incident but yes, the others much sooner. No other risk factors. I have only ever slept with one person unprotected and he does not have it (been tested recently). It was a large sneeze and his secretions went over my cut - I just wanted to reiterate because you said cough
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Thanks for the thanks, and for this additional information. However, it doesn't change my opinions or advice. The severity of sympotms argues against acute retroviral syndrome (ARS, i.e. the initial illness caused by HIV), which usually is a relatively mild illness. Please re-read my advice above about returning to your doctor and having an HIV test. I remain confident it will be negative. 

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