[Question #5489] Condom Broke - Symptoms Are Pointing To HIV/ARS - Please Diagnose

23 months ago
The timeline:

23/5/19
Had sex with an Asian massage therapist. Was protected sex but 10-15 seconds into it, the condom broke. I was very shocked but she didn't seem to be. We stopped immediately, and I asked her if she has been tested. She said yes, not sure she told me the truth. We changed condoms and continued with the session. I am uncircumsized.

1/6/19
Did a full STI test (Chlamydia, Syphilis, Gonorrhoea, ab/ag hiv) and all negative. 

Between 2/6/19 and 3/6/19
Slight aches all over the body, eyes, ears, chest, pain in finger tips. Joints were feeling uncomfortable too Was a little bump growing in the right ear, which was worrying.

4/6/19
Uncomfortable tingling sensations begin to appear in the joints. Not painful. I checked to see if they were swollen, but appears not. No rash, no fever anxiety and stressed kicked in, was up all night, didn't get much sleep.

5/6/19
Morning:
No rash and fever so far
Uncomfortable tingling sensations still at joints. 
Visited the doctor and he checked the throat, neck, elbow and knee and concluded there was no swelling.The doctor also checked the bump just inside the right ear and mentioned it was nothing to worry about, nothing to do with the lymph node, that sits behind the ear.Underwent another full STI test, the results will be out eta 7/6/19

Afternoon:
Temperature is on the up.  Fluxes between 37.2 degrees and 37.5 degrees.
No rash, no sore throat
Head is starting to throb a little
No intense fatigue, just a little rundown, still quite alert but also very anxious at the same time.
Uncomfortable tingling sensations still at joints but not painful
Slight muscle aches
On and off pains in the right groin area
A few dry coughs throughout the day, no sneezing.
Slight chills in the feet and hands.
23 months ago
*forgot to add, for further info, this happened in Australia and the massage therapist was from China.

Quick update as of 7.02pm, lump in throat, no sore throat, temperature is back to normal at 37 degrees, have a sore back, and muscle ache in thigh.  joints tingly and still uncomfortable but it goes in and out, anxiety level still high.

Thank you doctor, hopefully you are able to count this one as part of the first post and not the second!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome back to the forum. THanks for your continued confidence in our services.

You're too focused on your very nonspecific symptoms. (In medical speak, "nonspecific" means they do not point to any particular condition, and that the same symptoms occur in many conditions.) In other words, there is no reason to connect them to the sexual exposure you are concerned about. During the weeks before the symptoms started, in addition to the sexual event, you also had innumerable exposures to other people with possible colds or other minor health issues. Your symptoms do not even hint at HIV or other STDs.

Second, the chance of catching any infection during the few seconds of unprotected sex, after the condom, are very low. It is statistically unlikely your partner had HIV or any other active STD; and even when an active infection is present, most exposure do not transmit the infection.

Third, all STD and HIV tests are far more accurate than symptoms or exposure history. In other words, negative test results always overrule exposure history (no matter how high the risk at the time) and symptoms (no matter how typical they might be and regardless of their timing).

So I anticipate that your next round of STD/HIV tests also will be negative. When they are, you can move on without no worry at all about any infection from your encounter 6 months ago. If your symptoms continue, see a doctor to work out the cause(s) and possible treatments.

I'll be happy to comment again after your current test results are available, if you'd like to give me the results. But I won't have any other comments or advice until then. In the meantime, try to mellow out. You're fine.

HHH, MD
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23 months ago
Hi Doctor,

Thanks for the reply, appreciate as always. I will let you know the results when they come in tomorrow and we can discuss further. 

One thing I picked up in your reply, this is a clarification, not another round set of questions, you said the following:

When they are, you can move on without no worry at all about any infection from your encounter 6 months ago.

What did you mean by 6 months? This encounter only happened last couple weeks, e.g. 23/5/19 is 23rd May 2019. 

If you can shed more light on this, would be much appreciated, thanks.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Oops, I misread the date -- somehow I was thinking last December. My apology.

The currnent round of tests will not help much. The first tests, about a week after the event, were valid for gonorrhea and chlamydia (assuming urine or urethral swab specimen), with no point in retesting, so you can be sure those results will be negative again. The first syphilis and HIV tests show you were not infected before this sexual encounter, but were much too soon to pick up infections aquired a week earlier. Your current tests also are too soon to help very much -- better to wait until 4-6 weeks after the event. The negative syphilis test still will be meaningless. With the HIV AgAb tests, about 50-60% of newly infected people have positive results at two weeks, so that result -- which almost certainly will be negative -- should be somewhat reassuring.

As I said above, your symptoms are not typcial of a new HIV infection. I cannot say for certain you weren't infected, but the chance your partner had HIV was very low, perhaps one chance in a thousand; and even if she had it, the infection risk from any one episode of unprotected vaginal sex averages one chance in 2,500. Combining those two statistics, the chance you caught HIV is in the neighborhood of 1 chance in 250,000. If your symptoms were more typical, perhaps your concerns would be valid -- but really, there is almost no likelihood you have HIV.

But if you're intent on sorting out the HIV possiblities sooner, you could have an RNA/PCR test to check for the virus itself, the most direct way to diagnose a new infection. A negative result at this time would be 90-95% conclusive. But I strongly suggest you not seek such testing on your own, but see an expert in person.  Your nearest federally funded sexual health centre would be an excellent choice. Australia's SHCs are, collectively, the world's very best network of HIV/STD services. (If you're in Sydney or Melbourne, those SHCs are the best of the best.) In addition to advising on these technical aspects, they will know much more than I do about the likelihood that a partner like yours has HIV; and their in-person physical examination will also be helpful.

But I really don't think any of this is necessary. Your risk is extremely low and if you were my patient, I would not recommend further testing now, but only after a few weeks. But an SHC is an option if you feel you need even more reassurance than I can give.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Each question includes two follow-up comments/questions and replies, so you have one more coming. If you decide to get seen at an SHC, I recommend you hold any further comments unitl that's been done. I'm not likely to have any other significant advice until then.---
23 months ago

Alright, back from the Doctors and the 14 Day Ag/Ab test was negative. They didn’t seem to know / had access to PCR RNA tests (perhaps given that it’s only the local GP), so I will be conducting further Ag/Ab tests down the track.

As my last post for this thread, I’ve got a list questions, if you can please help that’ll be great.

1.     You mentioned that the odds of getting HIV with unprotected vaginal intercourse (if that person is infected) is 1 in 2500. Given that vaginal secretions have the ability to transmit HIV, and a penis that, was unprotected (like mine was), was in extensive contact with vaginal fluids, would it not be the case that it would possibly be even more certain the HIV infected vaginal fluid would get into my body and have a higher infection rate? I am just trying to understand this part further, why it is so low

2.     In the days leading up to an ARS or Acute ARS period, is there a gradual buildup of symptoms to the point where ARS or Acute ARS occurs, or do all the symptoms hit at once, at the same time and is severe?

3.     Since my last post, I’ve experienced various other symptoms such as itchy skin, itchy/lumpy throat, dry skin, general uneasiness and fleeting muscle/body aches at various places and more often than not at certain lymph node areas. Are any of these ARS symptoms? 

4.     An observation I made: When I wake up in the middle of the night to go to the bathroom or when I wake up in the morning, I do not seem to experience any symptoms listed in 2. Does the lack of symptoms during these somewhat relaxed moments in the day indicate that my symptoms are not ARS and maybe is something else? If ARS symptoms are severe, I would’ve thought the symptoms would disrupt my sleep as well and won’t stop just because I’m sleeping. Given this observation, would anxiety and stress be a possible cause of the mentioned symptoms in 2?

5.     If I were to get tested again Ab/Ag at 21 days and 28 days, how conclusive would they be?

6.     Given the above and the entire set of information and also the fact that the past few days since my last post my temperature has always been low grade (max is 37.7 degrees so far), there is no sore throat and no visible rash, what’s your outlook of my HIV status at 4 weeks and beyond?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Thanks for the follow-up information. It sounds like your GP is pretty knowledgeable. Still, if anything remains uncertain, you couldn't go wrong with a truly expert opinion, e.g. at your local SHC. Your negagive AgAb result at 2 weeks is highly reassuring.

1. The low rate of transmission for any one exposure is why HIV is so rare in most heterosexual populations (much less common than news media seem to suggest). The biological reasons are complex, but they have to do with the need for exposure to lots of virus, which must have contact with certain cells that typically are deep in the body or bloodstream. The 1 in 2500 risk is, if anything, probably too high -- the data orginate mroe than 10 years ago, before most HIV infected people were on anti-HIV drugs, as they are today. Anyway, there is no point in speculating about actual amount of secretions to which you might have been exposed. The data aren't that precise and such questions are unanswerable. But let's say a more intensitve exposure doubles the irsk. That's still only 1 chance in 1,250 per exposure.

2. ARS Symptom onset is usually over 1-3 days, with several symptoms more or less at the same time.

3,4. It is not possible to have HIV symptoms in absnece of HIV antibody. The symptoms are caused not by HIV itself, but by the immune reaction to it. Your negative AgAb result proves your symptoms are due to something other than HIV. And they don't sound at all like ARS anyway. And you also are right that intermittency of symptoms is more suggestive of a psychological origin.

5. Roughly 95% and 98%, respectively. At this point, I suggest you cool your jets and just have one more test at 6 weeks, with virtually 100% confidence you don't have HIV and that the next test will be negative. And you also should resume sex with your regular partner, if you have one.  That's what I would do personally  if I were in your circumstance.

6. One in a million, tops.

That concludes this thread. I hope the discussion has been helpful. 
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