[Question #5332] ARS Concerns

75 months ago

Worried I've ruined my life. On the 6/4/19 I got blackout drunk in HK. I woke in a flat with 2 prostitutes, I believe I gave/received unprotected oral sex followed by vaginal sex, I have no idea I work protection!

4 weeks of hell, my partner has been understanding but have all the signs of ARS.

I spent the 5 days following it, not eating/sleeping, experiencing night sweats on the 3rd, 4th & 5th day after, accompanied excessive diarrhoea on the 5th night.

6th & 7th day I had stiff, cramping shoulders/neck as well as a rash on my chest on the 7th day. I had a fever on the 4th/5th/6th & 7th day. The sore neck & shoulders remained but lessened over the coming days & I had 4 days of dry cracked lips & ulcers on my tongue.

I started to feel better, ulcers & lips cleared, cramps & muscle pain left & I thought it had passed. At 16 days the GUM clinic refused to test for HIV as it was too soon to test.

28/4/19 night sweats again & muscle aches/cramp in my thighs

29/4/19 night sweats, muscle aches/cramp in my thighs, shoulders/neck. I did a home HIV 1/2, P24 test = negative

30/4/19 aches/cramp in my thighs & shoulder/neck, chest rash

1/5/19 aches/cramp in shoulder/neck, sides of neck swollen & tender

2/5/19 aches/cramp in shoulder/neck, sides of neck swollen & tender, sore throat & night sweats

3/5/19 aches/cramp in shoulder/neck, sides of neck swollen & tender, sore throat & night sweats

4/5/19 day aches/cramp in shoulder/neck, sides of neck swollen & tender, sore throat & pain at the base my skull

5/5/19 aches/cramp in shoulder/neck, sides of neck swollen & tender, sore throat & pain at the base my skull

Would ARS happen after 3 days?

Would the Duo test at 22 days catch HIV?

I am in Japan and can only find 3rd gen ECLIA home test as I am not near English speaking doctors, when would this be conclusive?

H. Hunter Handsfield, MD

75 months ago

Welcome to the forum. Thank you for your question and your confidence in our services. I can hellp!

For sure you do not have ARS, and almost certainly you do not have HIV. First, this was a lower risk exposure than you might think. My understanding is that HIV is not common in female sex workers in Hong Kong. And when a woman has HIV, the average transmission risk is 1 in 2,500 for each episode of unprotected vaginal sex. That's equivalent to daily sex with infected women once daily for 7 years before infection is likely. (This is why many spouses of infected persons never become HIV infected -- which perhaps you did not know.)

Second, although some of your symptoms are consistent with ARS, they overall pattern is not typical. And three days is much too soon; ARS symptoms do not start sooner than 8-10 days after exposure.

Third and most important, your test results prove you do not have ARS. The HIV antigen-antibody (4th generation, "duo") tests are always positive in people with ARS symptoms more than a week in duration, and almost always the p24 test also is positive by that time. So your 22 day duo test is proof your symptoms are not due to ARS. It still is theoretically possible you caught HIV; it takes up to 6 weeks to be positive. But the negative test results still prove your symptoms are not ARS.

Finally, perhaps you will be interested to know that in the 15 years I have been doing this and a previous online forum (starting April 2004), with thousands of questions like yours, not one person has reported they became HIV positive. You will not be the first. If and when that happens, almost certainly it will be from a much higher risk event than you had, such as unprotected sex with a known infected partner, rectal sex between men, or shared needle for drug use.

I don't understand why you cannot get a lab-based AgAb/duo test. Such tests are used regularly in Japan. However, if you can only get the home ECLIA test, it would be conclusive 6 weeks or more after the sexual encounter, i.e. about 2 weeks from now. (That test by itself will be about 96-98% conclusive. However, the combination of that result plus your previous p24 and AgAb/duo test will be 100% conclusive.)

So your worries are over, or nearly so. You should resume sex with your regular partner, if you haven't done so (and if she is willing). There is no realistic chance you have HIV, and yoiu definitely can expect a negative result when you have a final test in a couple of weeks.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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75 months ago

Hi doctor, thank you for your prompt reply, I can’t explain what I’ve been going through over the last 4 weeks, a huge part of it is not remembering what happened. Also, I am engaged to be married at the end of the year, never cheated or wanted to so struggling to understand how this happened and then having to explain to my partner has been destroying me. As in crying in the office toilets and googling all night etc...

Not that I am doubting you for a second, with regards to ARS, would your assumptions be that this second bout, sweats, swollen neck, etc at 22 days wouldn’t be ARS either, presumably after my first lot of “symptoms”? Would you be worried about my neck/night sweats etc?

Slightly confusing with the testing as I ran out of characters to explain in my initial message but I work in Japan, I returned to the UK briefly and the doctor wouldn’t test. I left again, before returning to the UK for 1 day so I had a 4th gen Duo delivered to my home and send away at 22 days then I was back for that one day. I assume home HIV 1/2, P24 tests would be as sensitive to HIV and catch anything in this time frame?

There are very few English speaking docs I’ve been able to find, gum clinics don’t seem to be a thing here or the ones they have see 25/50 people a month (typically 2 nights a month, limited to 25 people)! I’ve even found one that saids “no foreigners!”

I did however find a company/lab who spoke English and distribute home 3rd gen ECLIA tests, my plan is to try and calm down and take this in 2 weeks.

I can’t thank you enough for your help, it’s incredibly reassuring, I hope this will be the last time I am in need of your services! You’re doing a brilliant job, I’ve been reading a huge amount of your work over the last 4 weeks!

H. Hunter Handsfield, MD

75 months ago

The "second bout" of symptoms cannot be ARS with the negative tests you have had. Also, your initial symptoms started too soon and the second bout seems to have started too late.

I meant to comment on the refusal of the UK clinic to test you. Although a negative result at 16 days is not proof against HIV, a negative result at 16 days is probalby 60-70% reliable, which can be reassuring if not proof. While we would not normally test so soon in my clinic, flexibility seems kind when a patient is particularly worried.

STD expertise in Japan is largely centered in urology; a urologist may be able to help. That said, I don't know about their expertise in HIV versus other STDs.

Thanks for the thanks. I'm glad my comments have been helpful so far. Let's hold off on further discussion until your next test is done -- you have one follow-up comment and reply coming, and seems best to save it until then.

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75 months ago

I appreciate this is a 3rd email, happy to pay for my next message

Very anxious again to the point where I cried in a meeting I was chairing today, not ideal!

A combination of me thinking it wouldnt have happened as I am not remotely interested, ashamed it could & the fact I didnt remember so tired to forget & focus on what I knew, led me not to mention it but I am worried I may have been anally penetrated

I remember almost nothing of the night but at one point I was on a couch and a “woman” I never saw undressed was touching me & my anus. I assumed it was her fingers but I then blacked out until it was over. When I woke, next day I was very constipated, had a painful anus, mucus there and a small amount of blood when I went to the bathroom

I only mention this because since I last messaged my neck has remained swollen at both sides, with pain in my neck, jaw and back of head has continued. It lessened today but I experienced the exact pain I did on the 12/04/19, 6 days after exposure. An intensely painful cramping in my left shoulder and neck that won’t subside reducing my mobility

Does this change anything with regards to my symptoms or my 4th gen test on the 22nd day?

Could ARS have started at day 20 so wasnt detected?

Part of me thinks its anxiety, part of me is seeking the worst as I cant believe all these physical symptoms are from nothing. I was panicked it might have happened the morning after and that one of the women wasn’t a woman

Apologies, I am aware it seems farcical

H. Hunter Handsfield, MD

75 months ago

This additional information does not change anything in my previous reply.

The purpose of allowing two follow-up comments is to complete discussion of a particular problem. Assuming nothing changes, we will have no more advice even if you post a new question, so I suggest you not do so, at least not until you have passed the time for conclusive esting -- 4-6 weeks after the last exposure, depending on what test(s) you have (discussed above). At that time, we can reassure that the negative results (which is what it will be) is conclusive. But don't post a new question until then. In the meantime, do your best to move on without worry.

I do hope this discussion has been helpful.

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