[Question #3638] ARS concern...

35 months ago
Hi,

I'll get right to the point here - Last week I had an encounter with a high end escort (I live in the US). Intercourse was protected with a condom. I performed unprotected cunnilingus on her for a few minutes. About 3 - 3 1/2 days later, I developed a faint cold or "flu-ish" feeling - light passing chills and a bit flushed at times, although I checked a few times and never had a fever. The next morning I woke up with a sore throat on one side and a corresponding single swollen glad  in my neck on the same side. No generalized swelling of nodes. No fatigue other symptoms. Basically what amounts to a very faint cold or flu feeling. Now, several days after the first symptoms, my sinuses feel a bit constricted and I have postnasal drip...which I'm assuming is contributing to the sore throat. My temp has bounced around between 97.6 and 99.1...in the normal range I'm thinking.

In short, is there any chance this could be ARS? My own research says no, and I've probably just got a cold. Most sites say ARS wouldn't show up for at least one week post exposure, but there are a few sites that it can appear in 2-3 days, and I want to be responsible about my health considering I date women socially as well. Since the symptoms of ARS mimic just about everything virus related, I'm guessing you'd way it against risk factor? From what I've read on this and other sites my activity was very low risk (cunnilingus being virtually risk free and the sex protected) but I'd like to be sure, or as sure as I can be. 

Doctors and the internet are often vague on this topic. Are there symptoms that clearly distinguish ARS from the common cold or flu? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum.

There is no realistic chance you have ARS. First, heterosexual HIV transmission remains more rare (in the US) than you might suspect from health education resources, the media, etc. Second, the frquency if HIV is generally believed to be especially low in esocrts (by which I mean high-cost sex workers by appointment, as oppsed to street workers, bar pickups, etc). Third, codoms work well to protect against HIV transmission by vaginal sex. (Congratulations for having safe sex!) Fourth, you correctly learned from your research before this question (thank you!) that cunnlingus carrlies little of any risk for HIV. There has never been a scientifically proved case of HIV transmission by cunnilingus. That doesn't prove it can't happen, but in general oral exposure to HIV is low risk, and with no proved cases, it has to be extremely rare.

And finally, your symptoms do not suggest ARS. They started too soon:  7-8 days is the earliest and generally it's 10 days or more. Further, although ARS can cause some of your symptoms, it does not cause nasal congestion or postnasal drip. Finally, as you say your self, these symptoms could be explained by innumerable other viruses, mostly mild and inconsequential.

So I agree exactly with your self diagnosis:  you caught a minor upper respiratory viral infection. It may or may not have been from the escort:  certainly the timing was perfect (3+ days is exactly the average for onset of symptoms from most URI viruses), but of course you could have had any number of other exposures about the same time with friends, co-workers, services personnel, etc.

So I really don't think you should be worried at all, and I recommend against testing for HIV. Certainly I would not feel a need for testing if somehow I were in you shoes. That said, anyone having sex outside mutually committed, monogamous relationships should be tested for HIV from time to time, like once a year. If you haven't been tested recently, this would seem a good time, when it's on your mind. But not because of this particular event or on account of your symptoms.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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35 months ago
Hi Dr. H,

Thanks for the reply and setting me at ease about that. I do get tested regularly, but I'm not due for my next physical for close to a year...so I was wondering if I needed to move that up. But I understand that's not necessary based on this experience.

Purely for my education, could you answer a couple of general questions related to ARS? 

Am I correct in thinking that the swelling of lymph nodes would be body-wide, and not limited to one area?

Is a fever always associated with it?

Is there a way to tell the difference between ARS and a cold or flu, other than evaluating risk factors?

Either way, I'll sign off and thanks again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the thanks. I'm glad to have helped.

I don't think it's very important for people to understand the symptoms of ARS. If someone has been at significant risk (e.g. unprotected vaginal or anal sex with a new partner of unknown status), s/he should be tested regardless of symptoms; or otherwise just get tested from time to time, like once a year, as you apparently are doing. So I really wouldn't worry much about ARS symptoms.

That said, ARS typically does not cause cold symptoms (nasal congestion, etc) or cough; usually causes some combination of fever, sore throat, widespread non-itchy skin rash, and enlarged lymph nodes, which typically are body wide (e.g. groin, armpits, groin, above the collarbones). Onset is generally 1-2 weeks after exposure.
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35 months ago
Thank you for the info and response! Just curious.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I'm happy to have helped. Best wishes and stay safe.---
35 months ago
Hi Dr H,

A nervous follow up here. About 10 days post event and now I actually do have a fever (101.3) and slight body aches. Was feeling 99% better but went to the gym last night (maybe a bit early) and felt rotten this morning. Sore throat is gone. Sinuses clearing. No other symptoms...today! Haha.

I'm guessing your opinion hasn't changed because exposure was still the same, but thought I should double check. 

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Correct:  I remain unconcerned about ARS, for the reasons you suggest. Also, fever without simultaneous sore throat, rash, and lymph node enlargements also is not likely ARS.

That said, given the timing and your concerns, it would make sense for your to see a doctor in the next couple of days It would be normal for you to remain anxious, regardless of my reassurance, until and unless tested to assure it isn't HIV. I recommend against doing this on your own -- see a doctor, ideally one with HIV knowledge and experience. 

Normally this thread will be closed at this time, but I'm going to leave it open so you can post the outcome if you are examined and tested. Be assured this doesn't mean I actually suspect you have HIV. I do not, so stay relaxed until you've been evaluated.
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35 months ago
First of all, thank you for keeping the thread open. Much appreciated.

I was tested at a local walk in medical clinic (blood test - ag/ab 4th gen) and came back negative. I had not thought that testing this early was viable or reliable, so I hadn't planned on doing it.

For what it's worth, as a follow up[ - my fever only lasted one night. I STILL have the sore throat and on again off again swollen glands ...two weeks now, but I'll see my PCP about that as soon as I can get an appt (they book up well in advance).

So I'm assuming I'm all in the clear at this point. Thanks for your advice and consideration.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
It isn't possible to have ARS fever or other symptoms and a negative AgAb (4th gen) blood test. So that result proves conclusively that something other than HIV was the cause. Anyway, as you seem to know, ARS fever and other symptoms last 1-3 weeks, definitely never as short as a day or two. Probably a garden variety respiratory virus.

Thanks for the thanks. I'm glad to have helped.
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