[Question #3438] Question #3416 follow up and second opinion

37 months ago
Dear Doctors, I'm a 35 years old male living in Qatar. You might think I have a silly question but I'm very stressed and anxious about it. I met an escort on Sunday February 25th 2018, the exposure was very brief. We French kissed for a maximum period of 20 seconds (on 3 to 4 parts) total kissing time 15-20 seconds. And she performed protected oral on me for about 4 minutes maximum. I'm more concerned with the kissing part, I didn't notice any blood in her mouth but I have some holes and cavity in my teeth. Symptoms: A. On Friday March 2nd 2018 (5 days of the encounter) I had slight sore throat. B. Saturday and Sunday 3rd and 4th March 2018 (6-7 days after encounter) I had fever of 100.5 maximum that goes down when I take paracetamol, I also had some rash on my torso and some slight night sweats and mild body aches. C. Monday 5th March 2018 (8 days after encounter) no fever at all, and no rash at all. But only sore throat. 
 Note: 1. I don't know the hiv status of the escort. 
2. It's flu season now in the area I live in, but if what Im having is flu nobody in my family cought it despite interacting with them. 
I know that there's only one documented case of HIV that transmitted through kissing however I just wish to get detailed answers to my questions below : 1. What are the chances of me having HIV? 2. Can ars symptoms come as early as 5 days? And then go away after 2 days (fever and rash gone but sore throat still there) 3. Does ars fever respond to paracetamol? My fever used to go down to normal levels after taking the paracetamol medicine. And as stated above the fever lasted only 2 days 
4. Is there anything I have to worry about? 5. I listed all the symptoms above, I didn't exclude anything from my description as I try to make the case very clear. 6. Kindly assess the situation I put myself in. Many thanks, and your efforts are highly appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome back to the forum, but sorry you found it necessary. I'm not going to repeat answers given in your previous thread except to confirm you had a zero risk exposure for HIV. ARS cannot start as soon as 5 days, and it always lasts at least 1-2 weeks. It sounds like you caught a minor respiratory tract virus (perhaps from kissing the sex worker, or from any friend or co-worker). That your family isn't affected doesn't make any difference in the likely cause.

1. What are the chances of me having HIV?  ZERO OR CLOSE TO IT

2. Can ars symptoms come as early as 5 days?  NO, TOO SOON. And then go away after 2 days (fever and rash gone but sore throat still there) VERY UNLIKELY FOR ARS, TYPICAL FOR A STANDARD VIRUS.

3. Does ars fever respond to paracetamol? PROBABLY YES, BUT WILL FEVER FROM MOST VIRAL INFECTIONS, SO THIS MAKES NO DIFFERENCE.

4, 5. No comment -- nothing to worry about.

6. Kindly assess the situation...  SEE ABOVE. IT IS EXCEEDINGLY UNLIKLEY YOU HAVE HIV. HOWEVER, I RECOMMEND YOU GET TESTED FOR REASSURANCE. THERE ARE EXCELLENT STD/HIV CLINICS IN DUBAI THAT OPERATE VERY CONFIDENTIALLY. YOU MAY FIND NEGATIVE TEST RESULTS TO BE MORE REASSURING THAN PROFESSIONAL ADVICE BASED ON PROBABILITY AND STATISTICS. IN THE MEANTIME, YOU CAN GO FORWARD WITH CONFIDENCE YOU DO NOT HAVE HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---
37 months ago
Many thanks Dr for your time and effort.

Is my risk zero or close to zero?
Does ARS symptoms come together and go together, or some symptoms stay longer than the others. 

Lastly I thank you again for your help, advice, and patience with me. I know that what I am asking is repititve and you told me earlier that there is no need for testing. But I will test just for peace of mind but I have to wait for 13 more days to cover the 4 weeks mark (4th gen combo) . I hope it will be negative. 

Thanks again and sorry. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Yes, your risk "zero or close to zero". I've said that several times. ARS symptoms usually occur all together and resolve together after 1-2 weeks; individual symptoms coming and going are not typical. But the most important reasons I'm confident you don't have ARS are that they started too soon and resolved too quickly, in addition to the virtually zero risk nature of the exposure itself.

I did indeed say testing was not necessary, and that's still true, from a strict medical or risk standpoint. But when people are anxious about such exposures, generally they are more reassured by negative testing than by expert advice. That's just human nature and I don't take it personally! But it seems clear you'll continue to worry about this until you've had testing to confirm my opinion and advice.

Normally threads are closed after two follow-up comments and replies, and we're there. But I'm going to leave this thread open for one more cycle. But no more discussion until you report your test result in a couple of weeks, OK? Stay mellow in the meantime:  it will be negative.
---
37 months ago
Thank you very much dr. 
I feel so much urge to test now (16 days after exposure). With 4th gen combo. 
I know it's too early. But please tell me what do you think. 

I'm extremely anxious and nervous and worried. 
37 months ago
One final and last question.
The fever and rash I had lasted 2 days only. 
My question about ARS rash. 

The rash I had fades with pressure. 
Does ARS rash fade with finger pressure?  If ARS rash  doesn't fade with pressure can i assume I didn't experience ARS at all and that Im all in the clear with regards to hiv?

Million thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
ARS rash lasts at least a week or two. It does not blanch with pressure, but that's the same for hundreds of skin conditions and it itself doesn't suggest ARS.

You definitely can expect a negative test result in a few weeks. Please note that repeated questions about the same exposure or disease risk, so do not be tempted to open a new thread to tell us the result. If negative, as it surely will be, we will simply confirm that for sure you did not catch HIV -- and that answer will be the same no matter what symptoms you may develop or what other questions may arise about the exposure. Thanks for your understanding.

I do hope these two discussions have been helpful to you. Best wishes and stay safe.
---