[Question #533] ARS Symptoms after Negative Tests

93 months ago
Hi Dr.

I thought I was done with this nightmare but it has come back and I am extremely worried. I received unprotected oral sex from a stripper on 10/9/15. Since then I tested with the following;

4 weeks all std's including HIV duo and all was negative

7 weeks blood duo negative 

11 weeks Oraquick saliva negative 

12 weeks Oraquick saliva negative 

13 weeks (93 days) duo negative 

15 weeks Syphillis RPR negative. 

Here is what worries me, around week 11 I developed headaches, They come and go briefly and feel like dull pains on both sides of my temples. Sometimes it affects the top of my head also. I also had loose stools in the morning, for some time. At week 15 while I was getting the headaches the day after syphillis results I woke up with a night sweat. It was a one time thing and it also seemed like my urine was cloudy.

Things seemed to get better then this week 18 I got it all,  sore throat, cough, mucous, fever blisters on my lip, headaches, body ache , sore muscles, diarrhea (only in the morning for 2 of the 7 days), my wife also has a sore throat and bad cough, (she is coughing as I write this). She also had a night sweat. Could this be ARS? The only thing I didn't get was a fever. It seems my symptoms started around week 8 and have peaked this week. 

cdc says 97% accuracy at 13 weeks. I play poker and 3% chance happens all the time. Should I retest now or wait till symptoms clear? I believe 6 months is 100%. I am horrified, I can't sleep Doc. The tests were done at Kaiser not sure what type, if the blood is a rapid or not. 

Edward W. Hook M.D.
93 months ago

Welcome to the Forum.  I'll be pleased to comment.  the bottom line however is that you do not have HIV and that your current symptoms are due to some other process, possibly a persistent, non-STI viral infection of the sort that most persons get from time to time.  Below I provide a variety of facts which are what lead me to my statement.

1.  Starting with the CDC, their estimate is overly conservative.  Please remember that, as a politicized, governmental agency, the CDC cannot (at least in their mind) "afford" to be wrong.  Further, they mush abide by statements made in other government--approved documents such as FDA-approved package inserts for test performance.  As a result their official estimates of test performance are overly conservative.  The fact is that antibody only tests for HIV are all positive by twelve and almost always by 8 weeks after an exposure in which HIV is transmitted.  For the newer, "4th-generation" tests results are completely reliable 4 weeks after exposure.  Once tests are positive, they remain positive for life.  Thus each of your tests taken at 4, 7, 11, 12, and 13 are all conclusive and should be believed.

2.  Your exposure was low risk.  Most persons, even most commercial sex workers, do not have HIV.  Even when they do, most exposures to infected partners do not lead to infection.  There is some site-to-site variation in the efficiency with which transmission occurs (see no. 3 below)

3.  There are NO proven instances in which receipt of oral sex has led to acquisition of infection by an uninfected sex partner. 

4.  The timing of you symptoms, as well as the fact that your wife appears to have come down with the same sorts of problems is much more compatible with a more usual, viral syndrome than any STI, including HIV.

for all of these reasons, I suggest you do your best to stop worrying. If you cannot, then I suggest you seek formal help in dealing with this.  I realize that he internet may raise concens but I can assure you that you have nothing to worry about related to the exposure you describe above and have no reason for further STI testing of any sort related to this event.  EWH

93 months ago
Dr. Hook,

Thank you so much for taking the time to explain in detail. When I think through the logic of the situation the fluid I was exposed to was saliva so it has to be low risk to no risk. That coupled with the fact of 5 tests, 3 that look for disease and antibody and 2 antibody only and your reassurance should be it. 

These headaches for weeks and diarrhea and other odd symptoms I have along with reading conflicting information online gets my worried though. Is ars even possible at 16-17 weeks out? I read another post that test results outweigh symptoms but my strongest symptoms came on after my last test at 13 weeks. My wife has a really bad cough right now and I have a pounding headache. I don't even know if cough is an ars symptom but I get so scared, I guess it's the guilt that manifests into a fear of having my worst nightmare of hurting her health in the worst way possible by passing on a disease for a moment of stupidity that keeps me up. 

Did the cdc come up with 97% accuracy at 3 months before they implemented the duo test? I hope that is the case, I really don't want to test anymore and want to let this go. 

I'm more or less ranting here, thanks again for your time Dr. 

Edward W. Hook M.D.
93 months ago

I think you are being mis-led by the internet. For the ARS to come on more than 12 (or even 8) weeks is unheard of.  Further, while cough IS a symptom of many viral infections, it is not a typical symptom of the ARS.

The CDC's assessment is out of date and does not reflect current data on the more recently developed 4th generation tests.  there is no need for further testing related to the exposure you described- really.  EWH