[Question #4597] very worried

26 months ago
Good day to you Doctors.  Thank you in advance for your service.  Getting right to it, I am terrified that I may have contracted hiv.

On 11/20 took a plane trip to another state.  Afternoon of 11/20 had PROTECTED vaginal sex with high end black CSW (condom did not fail, I checked it).  UNPROTECTED and vigorous oral sex between us both ways.  If it matters, I have had gingivitis off and on for awhile and have bleeding gums damn near every other day.  Even just a few hours before this stupid encounter when I brushed my teeth.

11/23 I flew home

11/26 near midnight or morning of 11/27 explosive diarrhea.  Beginning  "flu symptoms."  Diarrhea was gone by noon/early afternoon of 27th.  Back to solid stool at that point.  Flu-like symptom persists to this moment.  And it feels weird like never before in almost 50 years.  I have felt like I have fever, pressure/flu like feeling in my head, mild headache,  pressure behind and in my ears, behind my jaw, but I cannot get a thermometer to say I have a fever.  I have had fever in the past many times and this sure feels like it but 5 different thermometers won't even register past 97.3.  Most of the time it's between 96-97 the past few days.  Is that normal to be consistently below 98.6?  Is low temp a symptom of ARS.

I have had no sore throat, cough, or phlegm.  No body or joint aches at all.  No swollen lymph nodes.  No rash.  And the feverish/flu feeling I have comes and goes.  Also it is very mild.  But definitely there every day.

Today, 12/1, I visited at length with my PCP on her cell phone.  I told her every detail.  We set an appt for Monday but she says I have to wait a few weeks for testing.  She told me this was very low risk.  I read a couple comments corroborating that on this site as well.  But, there is so much other info out there that directly contradicts that.  As in this is definitely ARS symptoms according to what I read and the timing is just horrible for me.  I have read that ARS symptoms can vary from none at all


26 months ago
Whoops.  That was a misfire.  Anyway, I will shut up at that point.  Please let me know what you think is going on Dr's.  Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum and thanks for your confidence in our services.

All things considered, this was a low risk exposure. Perhaps most important, your symptoms are not as suggestive of HIV as you seem to think.

The exposure:  HIV is rarer than you might assume in heterosexual women in North America. Even among the most sexually active, on average the chance is probably 1 in a thousand, and not reaching 1% (1 in a hundred) even for commercial sex workers. Second, condoms work very well in preventing HIV transmisison, so the vaginal sex isn't a concern. Finally, oral sex has never been scientifically documented to transmit HIV oral to penis. Probably it happens, but an estimate by CDC is that on average the risk is 1 in 20,000, if the oral partner has HIV. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. Although in theory inflammatory conditions in the mouth (gingivitis and the like) might elevate the risk, even if aht doubles the risk, we're talking about 1 in 10,000, or once in 27 years.

As for your symptoms, diarrhea is rarely the main symptom of ARS. And you might mis-understand the term "flu like" you see in many lists of HIV symptoms. That term means headache, widespread muscle aching, and fever -- but you say you've had none of them. (I'd be interested to know what you felt and thought were "flu symptoms".) And no, ARS does not cause subnormal temperature -- and yours hasn't been below normal anyway. 98.6F is the average body temperature over the course of 24 hours, with actual number varying from roughly 96.5 to 99.5 from hour to hour.

In other words, I agree exactly with your doctor. As for "so much other info out there that directly contradicts" all this, that's an artifact of the websites or other sources you have seen. If you'll limit your web exploration to those run by health agencies, academic medical centers, and professionally moderated forums like this one, you'll only see information similar to what I've said above. Especially avoid sites run by and for infected people, those anxious about particular exposures, and the like. And basically never believe anyone who claims to have been infected with HIV other than by overt blood exposure (e.g. needle sharing) or unprotected vaginal or anal sex. Those who claim otherwise almost always are intetionally untruthful, or misunderstand the actual source of their infections. (90% of HIV infected people are unable to pin down a specific exposure as the source.)

So what IS the cause of your symptoms? Almost certainly a garden variety viral infection. If you have young kids at home, you probably caught viral gastroenteritis (e.g. norovirus) from one of them. Or a contaminated airplane toilet. Or any of all the people with whom you shook hands or handled your credit card during a purchase. Or even your extramarital sex partner -- although such infections usually have onset of symptoms within 2-3 days, so that's less likely.

While I agree with your doctor's risk assessment, you really don't need to wait several weeks for an HIVtest. An AgAb (antigen-antibody, "duo", "4th generation") blood test detects ~90% of new infections by 3 weeks, so a negative result at that time would be highly reassuring, although not perfect. It is true that you have to wait 6 weeks for truly conclusive testing.

Bottom line advice:  1) Stop worrying. 2) Stop searching online about HIV risks and symptoms. 3) Continue your normal sexual relations with your wife. 4) Ask your doctor about an earlier HIV test. 5) Consider checking out this advice with her. (You could print out this thread as a framework for discussion.) 

I hope this information is helpful. Best wishes--   HHH, MD
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26 months ago
Thank you so much for your reply Dr.  What I thought were the flu symptoms were as I mentioned.......the short bout of diarrhea (it only lasted about 12 hours), mild constant headache, mild pressure in my head, behind and in my ears, behind my jaw.   

In addition, a very "feverish" feeling, but intermittent.  It does seem to worsen when I am still or at night laying in bed.   I am nearly 50 and have had fever many times.  I feel exactly like that right now.  A little mild, but enough of a feeling that I am checking my temperature a couple times every day.  If it matters, it has not gone over 97.3 according to the thermometer for nearly a week.  What I don't have is the typical head cold/flu stuff I have had over the years.  No sore throat, no congestion, no cough, no runny nose, no body aches, no rash,  no swollen lymph nodes etc.  But still, that cold/flu fever pressure/discomfort  feeling in my head.  At this moment, as I type, the pressure in my ears and head is almost identical to feeling the need to exaggerate a swallowing to relieve the pressure in an airplane, albeit mild.  

Furthermore, my primary concern was my performance of cunnilingus on the lady and the existing gingivitis/bleeding gums.  They had bled early in the day before I saw her.   That is my main fear.  

Finally, thank you so much for the reply and the advice.  I have already emailed a screen shot of this conversation to my PCP.  I am thrilled that you agree with what she said.   You provide a wonderful service for us ne'er do wells in the world of bad choices.


26 months ago
Did my previous response show up?

I suppose my main question/fear is if contracted, can HIV present with a short 12 hour bout of diarrhea and then a mild headache and feverish feeling. With NO fever or other symptoms.  
26 months ago
I am starting to wonder if I fell through some cracks here?  I have seen my doctor and would like to speak with you Dr. HHH
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Oops -- my fault. Apologies! I saw this yesterday, started to formulate a reply in my head, then thought I had done it (I guess). (Moderators are human too!)

You misunderstand the meaning of "flu like" Influenza doesn't cause diarrhea at all. (Don't confuse it with viral gastroenteritis, i.e. "stomach flu; entirely different.) A feverish feeling, without fever, doesn't count either; "flu like" means actual fever documented with a thermometer. Pressure in head and ears is typical of a common cold, but these are not "flu like"; influenza does not generally cause cold symptoms like runny or stuffy nose (although it does cause coughing).  The point is what health experts and public heath agencies mean by flu symptoms is as I said above, mainly headache, widespread muscle aching, and fever. It seems you had none of them.

The bottom line is that this additional information does not change my professional assessment or advice. Your personal physician is right. (sounds like you have a good one -- keep her!)

No, HIV is not a likely cause a brief (12 hour) episode of diarrnea.

Sorry again for the delay in responding.
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26 months ago
Thank you so much for the reply Dr.  I still have those same symptoms.  Today is the 8th day of that pressure/mild headache/feverish feeling.

It is not that I don't trust my doctor, but she is a regular family practitioner, not an STD expert.  Regardless, here is what she had to say and I wonder if you agree with her assessment.  

When I saw her, she drew blood and did a urine test.  Everything came back negative EXCEPT hsv1.  She swears to me that the majority of the U.S. carries that infection and that it is no big deal.  She did not do hiv yet and told me that she wanted to wait until 3 weeks had gone by.  She is also adamant, like you, that she does not think my exposure resulted in infection, but acknowledges that it is a remote possibility.   

Further, she was very clear in stating that hiv does not just present as mild headache only with no fever, sore throat and body ache.  She also tells me that while less common, it can also cause a rash on my chest.  According to her, you have to have a majority of those symptoms all at the same time, and the timing of my symptoms showing up at 7 days is purely coincidental.  She is testing my thyroid and some other things to try and determine what is causing that pressure/feverish feeling.  Do you agree with all of this?

After our phone conversation, and before my appointment, she visited with a colleague who deals with infectious diseases.  I have never seen this doctor.  I guess they had coffee or something.  Anyway, in regards to my fear of the cunnilingus, he stated to her that "your patient cannot conceive of just how low of a chance transmission is, even with bleeding gums or gingivitis."  Do you agree with that as well? 

Yes Dr. H, I do have a good doctor.  She has been my PCP for almost 20 years and is a talented, small town doctor.  She makes herself available by phone, cell or land line, to all of her patients at any time.  So yes, I will keep her around.   

Thank you again for your time and advice regarding this.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
I continue to agree with your doctor, including her comments about your HSV1 blood test result. And with the informal opinion she got from her ID colleague. Along with her, I remain confident your symptoms for sure are not due to any infection of any kind from the sexual exposure you are concerned about. And if you think logically, in the last few weeks, in addition to that even, you have had innumerable contacts with other persons (at cash registers, socially, etc, etc); perhaps been around kids with viral infections (it's that time of year), and so on. This event has emotional resonance for you, but there is no biological reason why it is any more likely thea source of your symptoms than all those others. (See what your doctor thinks of that statement -- I'm confident she would agree.)

That completes the two follow-up comments and replies included with each question and so concludes this thread. And the timing is good-- this forum has nothing more to offer you at this time. If you're tempted to post another question about it all, I strongly recommend you not do that until your HIV test result is finally availalble. (And when it's negative, you probably won't feel the need anyway.)

I hope the discussion has been useful. Really, mellow out. You're fine.
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