[Question #4358] Worried about HIV, Unprotected Vaginal Sex, please help

28 months ago

I did not have any sex for 4 months. I met a girl on a sugar dating site 09/01. We dated for the next two weeks and we went in for complete STD testing on 09/15. We both came back negative on HIV. We then had our first and only unprotected sex on 09/28. 

I asked the girl twice and she has said that she has not had any sex from August until our first sexual encounter. She is sexually adventurous. I trust her, but being afraid, my mind tells me one never knows.

I had a painful bump under my left armpit on 10/03. I went to urgent care center, diagnosed as furuncle, prescribed Augmentin (875 amoxicillin 125 clavulanic acid) twice a day.  Started the medication on the evening of 10/05. Noticed my gums being extremely sensitive and painful to brushing the evening of 10/06. I stopped brushing. Noticed subtle bleeding in my gums on 10/08. If I put a tissue on my gums for a few seconds, I see subtle red spots. So they stopped the medication, prescribed me another antibiotic. Stopped taking medication evening of 10/08. Its 10/09 morning and my gums still bleeding. My tonsils are swollen/painful, but that happens often as I get nasal allergies/drip and swallowing that I believe causes it. I do not seem to have any other ARS symptoms at the moment.

Are my symptoms, 10 days after sex, related to ARS at all? Do amoxycillin and clavulanic acid, may cause bleeding gums individually or as a combination medication in Augumentin? Some internet websites state that both components in Augumentin may cause gums to bleed.

I/We tried to do everything right. Shall I we go for the RNA test? I am afraid for RNA as I have heard that it may give false positive. Would it be better if I go for RNA and HIV combo test for peace of mind? If yes, when? I would ask her if she may come too, but don’t know if she would.

Am VERY afraid. Please advise.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to our Forum.  Let me start by congratulating you on your approach to this relationship.  Testing prior to sex is a great way to start a relationship and it virtually guarantees that there was no risk for STI infection, including HIV at the time of the sexual encounter you describe.  Presuming that the HIV tests that you both had were combination HIV antigen/antibody tests (pretty much the standards for testing at this time), there is no reason to concern about having acquired HIV.  Thus I would assume that your recent furunculosis of the armpit was a coincidence and nothing more.  Neither furunculosis nor bleeding of the gums are typical signs of the ARS.

If you and your partner choose to test, I would recommend a combination test over the RNA test.  Either test would be positive if you were having the ARS (I am confident you are not) and there is less chance of a false positive from the combination test.

I hope this information is helpful to you.  EWH
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28 months ago

I talked to the girl about this and she vehemently denied having had sex since July. My gums are actually bleeding more after I brush my teeth. I see blood after I spit the toothpaste. As mentioned earlier, this started when I took Augmentin. But I have stopped taking the medication since 2 full days now and still the bleeding gums issue would not resolve. My gums never bled like they are now. So my worry is this may only be happening either due to Augmentin or ARS. What else could it be?

Q1] Do you think the components in Augmentin may be causing this? As I said, some websites make a mention of that. If it may be because of that, how long it may take to resolve itself?

This is freaking me out. I have read that gum issues start late into HIV infection.

Q2] You say bleeding gums is not typical of ARS, but does it happen at all, though atypical? Does ARS start just 10 days after exposure (today is day 12)?

Q3] I do not yet have any other symptoms. Just swollen and painful tonsils that I get often. But could it be related to ARS this time around?

Q4] I was thinking of doing a duo test after 3 weeks since it is more accurate then. I have read it is conclusive at 6 weeks. But given everything that is going on, would you recommend I do a duo test right away?

Since this is not a normal dating/relationship, I don’t want to ask the girl if she would come with me for testing. I would go do it myself if and when needed.

I really appreciate your help in navigating this tough situation. I would be grateful if you may address my four questions above.

 

Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
1.  Gum disease and bleeding is not a typical manifestation of the ARS or of a penicillin (augmentin) reaction.  Presuming that the bleeding you have noted is around your teeth, rather than guessing or searching the internet (which is far more likely to mislead you than help), I would see your dentist.  This is likely some other sort of gum disease totally unrelated to your sexual activity.

2.  ARS could begin around day 10 but is VERY unlikely given the information you have provided.  I have never seen or heard of bleeding gums as part of the ARS.

3.  Once again, there are really no good reasons for you to be worried about the ARS. NOTHING you have described suggests ARS to me.  I worry that you have been misled by the internet and are overreacting. 

4.  Sigh, if your symptoms are due to ARS your test will be positive today.  No need to wait.  I suggest you go get tested so that you can stop worrying needlessly about ARS.

EWH
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28 months ago

Hello Dr. Hook,

From the bottom of my heart, thanks for your advice. I still have a couple of questions for you and I would be grateful for your advice.

 So I think the gum bleeding issue I was harping on, must have been thrush after all. I get white/creamy coating on my tongue and the bleeding is not around teeth but on the soft tissues below the gums. This is resolving by itself now. I noticed the bleeding on day 10 and white/creamy layer on my tongue on day 15 after the exposure.

 Q1] I am hoping this might have happened as a result of the strong antibiotic I took for 2 and a half days and not ARS? And if it was the tests I describe below might have caught it?

 I went in and did HIV RNA and IV generation combo test 12 days and 18 hours after exposure at quest diagnostics and both came back -ve. I know everywhere it’s said that the gold standard for conclusive result is after 6 weeks on a combo test. However, I am anxious and would be grateful to know your opinion on how good an indication these test results are on my status regarding HIV. Dr. Handsfield seem to suggest that the RNA test by itself may be a pretty good indication, albeit more than 5 years ago on a post below:

 https://www.medhelp.org/posts/HIV---Prevention/RNA-and-oraquick-swab-test-/show/1891685?li_source=LI&li_medium=default-widget-bot

 Q2] Is that advice still valid or not anymore as I understand things change with more information becoming available in the following years? I would still do the 6 week combo test if you recommend. I might even do one combo test at 4 weeks.

 I do not seem to have any other symptoms at the moment. I am in a sugar dating relationship for the first time, and I think in addition to everything, I am experiencing guilt for some reason of having unprotected sex. On second thoughts, I am not sure how trustworthy these relationships may be. I hope it is just that and nothing serious. Hopefully this would be the last and I would not have to come here again for this episode. I also know that I am not allowed any further follow-ups.

Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Your final follow-up questions are a bit repetitive.  Briefly to your questions:

1.  Yes, thrush, if that is what the problem was, is often associated with antibiotic use. there are many causes of white exudates in the mouth however.  If a doctor did not diagnose thrush, you really do not know what the white material was, although you can be entirely confident, based on your test results, that it was not HIV.
2.  If your symptoms were due to HIV, the testing you have already had would have detected it.  RNA tests are definitive after about 2 weeks after exposure. they tend to be more expensive than other tests and have a slightly higher false positive rate.  You were fortunate not to have a falsely positive test. That said, your negative RNA test is further conclusive evidence that you did not  have HIV and that your symptoms were not due to HIV.  Give up on the idea that you might have HIV-- you have proved you do not. 
3.  Your RNA test is definitive.  You do not need further testing for HIV of any sort related to the events you have described. 

I hope my responses have been helpful. As per Forum guidelines this third response will be my final response to your questions.  Please do not continue to worry about HIV- you have proven you do not have it. EWH

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