[Question #394] ARS symptoms

34 months ago
Hi doctor wish you a happy new year
This is my story
On 17 December I engaged with protected vaginal sex with a street hooker I used a condom but I don't know if the condom is latex or not as I heared before some kind of condoms not effect with HIV, no kissing and no oral sex, the intercourse is just 15 second and for the best of my knowledge the condom remain intact and didn't slipped off but I didn't remove it after finish in the right way.
On 31 December After two weeks I took HIV combo test which came back negative,
The next day which is yesterday I wake up with sore throat, upset stomach, diarrhea, I took my fever doesn't exceed 99 f (37.2 c) 
Please note that my symptoms still and today I wake up with one white sore on my face
These symptoms freaked me and need your clarification:
1) is this ARS symptoms ?
2) is this true that not all condoms effect with HIV?
3) what is the reability of my HIV combo test after 2 weeks?
4) do I need to retest at 28 days and if yes what is my chance to be negative?

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to our Forum.  We receive many questions about the ARS.  The ARS is a flu-like syndrome which some but not all (and perhaps not even most) people who get HIV experience early in the infection, typically 1-3 weeks after the exposure that led to infection.  The symptoms of those of the sorts of non-STI viral infections that most people get from time to time and include high fever, a rash, muscle and/or joint aches and on some occasions diarrhea.   Among at risk, sexually active persons who experience these symptoms, less than 1% have HIV and the rest have the sorts of viral infections I mentioned above.  Thus the symptoms you have are compatible with the ARS but it is most unlikely that you have HIV.   I say this because:

1.  Most commercial sex workers do not have HIV.

2.  Only 1 in 1000 unprotected sexual exposures to infected sex partners, on average, lead to HIV infection.

3. Your exposure was condom protected and condoms work.  Most condoms used by commercial sex workers are latex and even if a non-latex condom was used (most unlikely) while they are not perfect protection they reduce the risk for infection somewhat.

4.  Your condom did not fail.  If it had, you would have been aware.  When condoms break, they break wide open leaving no doubt that they broke.

5.  While combination HIV tests are not completely reliable until 28 days after an exposure, at 14 days post exposure, they detect most infections and this is particularly true if you were going to develop the ARS the next day

For all of these reasons, I am confident that your symptoms are not the ARS and that you did not acquire HIV from the exposure you describe.  For your own peace of mind however, you may wish to re-test again with a 4th generation, combo test 4 weeks after your exposure of concern.  I am confident that when you do, the test will b e negative. 

I hope these comments are helpful.  EWH


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34 months ago
Thank you for re assuring doctor
Just one more clarification, I start to recover today from my symptoms, so I if it ARS it will continue more than three days is this true?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
There is no reason for you to think your symptoms are the ARS.  The duration of the ARS however can be just a few days however.  EWH
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34 months ago
Dr. Edward:
I know that I disturb you too much but I'm so stress , today I have a rash all over my face my back and shoulders also I have discomfort feeling in my armpit and growin area,  I have runny nose with sneeze, also I feel feverish on my head but no fever (max 36.8),  I'm planning to make combo test on Thursday which is 3 weeks mark because I can't wait more,  how riable this period?
If I was your patient and explain to you my exposure and symptoms do you recommend HIV test?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Final answer.  At three weeks if your current symptoms were due to HIV the combo-test would be positive.  Your symptoms however are far more likely to be due to a flu-like illness or some other, non-HIV cause than HIV.  If you were my patient I might order the test for you (once) to provide you with reassurance that you did not acquire HIV from the exposure you have described but then would not repeat it again in the future if you were still concerns.  EWH
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34 months ago
Thank you doctor you are always right, the combo test today came back negative my symptoms not related to ARS.
Thanks again for assuring me.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I'm glad I could help.  EWH
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