[Question #4477] HIV infected from unprotected oral and fingering

30 months ago
Hello,

I am reaching out because I feel that I may have been infected.  I have read through a ton of the questions / replies for risk and figured that I would ask anyway.  I understand that both of the activities are low-risk and don’t believe that I am the anomaly.  No escuses, but on 28 April I engaged in receiving oral sex from a female that I don’t know.  While receiving oral from her, I fingered her vagina until I came in her mouth.  I bite my nails often to include the cuticles and can’t help but to believe that I was infected by this incident.  At 8-9 weeks time I began to feel fatigued and the lymph nodes in my groin aching and about a week later is when my poor appetite began followed by vomiting and sore joints, muscle aches and a coated tongue. I also have lost about 15lbs.  I am sure of what I will be told about symptoms however I felt the need to mention them. It is now 4 November and I still have the poor appetite as well as a fullness in my stomach and sore lymph nodes/swollen in my groin.  I can only pray that I didn’t step on it and become infected by such a selfish act.  Thank you for listening and I await your reply!  Thoughts?
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome to our Forum. thanks for reading our replies to other clients and for appreciating that, because our replies are based on the available science, this response will provide similar information.  To briefly summarize, because you have visited other responses to other clients, you know that:
1.  Most commercial sex workers do not have HIV.
2.  That, if a partner has HIV, the risk for infection varies with the sort of exposure and that acts such as receipt of oral sex or masturbation of an infected partner in which you are exposed to their genital secretions are no risk events for which there are no instances in which HIV infection has resulted from these acts.
3.  The when a person feels guilty or anxious about an exposure they sometimes repeatedly examine themselves, detecting what are otherwise normal findings.  This includes detection of lymph nodes which can become tender with repeated examinations.
4.  That guilt and anxiety over sexual exposures can sometimes lead to depression with the resulting symptoms of loss of appetite, sleeplessness, weight loss, etc.  

You do not mention testing in your note.  I would suggest that you test for HIV.  Virtually any test you have available will be reliable at this time and will give the same result, proving that you were not infected by the activities you describe. If you do test, before you test, I suggest you understand that currently available tests for HIV infection are some of the most highly evaluated and most reliable tests in the history of medicine.

I hope these comments are helpful.  In addition, I have two other suggestions- first that you stay off the internet because there are so very many incorrect and misleading statements there and, secondly, that consider seeing a trained health care professional - either your own doctor or a mental health, depending on whom you think might be most helpful.  I suggest seeing a trained professional because of the fact that you have lost weight-indicating that this is affecting your health.  EWH
---
30 months ago
Doctor, thank you for the quick reply.  I have a few questions that I hope you will consider answering for me.  

1.   Based off of these occurrences, would you suggest that I be tested?  

2.  Is there a likelihood that I was infected by receiving oral and fingering a high-risk woman?

3.  My wife was also vomiting with fever and nausea and so was our nursing daughter.  It has since passed and you’re right.  I let the depression and my diagnosed anxiety get the best of me and began to not eat thinking that I may have  infected my family.  I have since began back eating and I started to gain some weight back.

4.  Do ARS symptoms usually appear at 8-10 weeks?

Please advise!  I really would like to put this past me.  I have spoken with several other doctors/forums and they have said that there was no risk aside from one online doctor who said that I had an actual risk. 
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
I find questions 1&2 a bit repetitive and believe that they were answered in my earlier reply.  Here are my replies:

1.   Based off of these occurrences, would you suggest that I be tested?
Testing is a personal choice.  From what you have said, I see no medical indication for testing however, if it will give you peace of mind, then there in nothing to be lost with testing.  

2.  Is there a likelihood that I was infected by receiving oral and fingering a high-risk woman?
Virtually zero

3.  My wife was also vomiting with fever and nausea and so was our nursing daughter.  It has since passed and you’re right.  I let the depression and my diagnosed anxiety get the best of me and began to not eat thinking that I may have  infected my family.  I have since began back eating and I started to gain some weight back.
Thanks for the additional information  It sounds like there was something that was passed around within the family- most likely a community acquired viral infection.

4.  Do ARS symptoms usually appear at 8-10 weeks?
ARS symptoms typically occur between 10 and 30 days following infection.  For ARS to occur 8-10 weeks after infection is virtually unheard of.  

I hope this clarifies things. EWH

---
30 months ago
Dr.  Hook,

This definitely clarifies things for me and I feel much better already.  Thank you for your professionalism and for being a great and well respected Doctor.  

One thing that I would like clarification on is as follows.  I actually had sex wife my wife about a week after receiving the oral and fingering the young lady.  I then became sick about a week prior to my wife and daughter.  My wife was nursing my daughter and that is why I believed that I had infected them both.  Another thing that is bothering me is that our 10-year old son was the only person in our home without the fever, vomiting and nausea... maybe the sickness missed him however even our at the time 6-month old daughter had those symptoms.  Everyone in the household eventually got well but my wife acquired strep throat twice since this timeframe as well as our 10-year old son.  The baby is now 10-months old and doing well besides what seems to be a continuous cough and heavy breathing.  I unfortunately ran with what I read on the internet and thought that she had PCP from HIV.  I haven’t had any other contact with anyone since this incident.

And last but not least, why does the CDC, Health department and other health organizations state that ARS can appear between 2-8 weeks?   Also, what could be the cause of the lump in my groin next to my penis?

I will not bother you any further as I know that you are extremely busy.

Once again thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Thanks for the clarification about the sequence of events.  This does not change my assessment regarding your likelihood of infection however (zero), the resulting risk to your wife from unprotected sex (zero) or whether or not this was the ARS (it was not). The most likely origin of the family's illness remains a "usual" community acquired, non-HIV virus.  The coincidental timing interacted with your recollections (and possibly guilt) over your extra-marital encounter to make you miserable and overthink things.  

Regarding your question about CDC and health Department advisories, please let me remind you that your local health department takes its lead from the CDC and the CDC, as a politically influenced governmental agency which provides indirect, general guidance to millions of people has adopted the philosophy that they cannot "afford" to be incorrect and, as a result, tend to be overly conservative in their advise, using quite conservative time intervals for the information they provide.

Finally, I would guess that the "lump" you have detected is a lymph node detected as you looked for signs of HIV.  Swollen lymph nodes in the groin are common and non-specific and could result from a past infection, anywhere below your waist, including processes such as athlete's foot or a scrape.  It is not a reason for concern.

This is my 3rd reply as part of this thread.  Forum guidelines call for up to three replies to each client's questions.  Thus, this thread will be closed later today without further replies.  Take care. Please don't worry.  EWH
---