[Question #6295] Symptoms and Risk Assessment

16 months ago

Hello Doctors,


Thank you for all you do for the concerned people using this platform. Your thoughtful and informative replies provide important information and help dispel inaccuracies; I've resorted to your assistance a number of times.  This time around I have the following question:


I don't have a regular partner at present,  and I'm trying to do my best to engage in safe sex.  This means using a condom as a barrier in each instance of sex, aside from oral sex.  Three weeks ago I had sex with a man and that was the practice - a condom was used for vaginal intercourse but not for oral sex.  I don't know his status, he doesn't know it either (hasn't been tested before).  I'm not sure whether the condom was put on properly, but I think it may have, and I don't think it ripped (I would see it if it did, I imagine ). Also, if it did tear apart, I'm assuming I'd see and feel the semen in/on me since my partner ejaculated intravaginally.  Anyway, I'm concerned because I had the following possible symptoms:


Day 8-9 - weakness, diarrhoea (a few times), conjunctivitis (likely unrelated), rhinitis, just an overall feeling of under the weather

Day 14 (two weeks after) - occasional low-grade fever, headaches, weakness, sore throat, coughing


All in all, symptoms have lasted about a week after Day 14 (into the third week after the 'event') and have mostly resolved by now, with some remnants such as coughing and rhinitis still ongoing. I haven't yet tested with the combo test but planning to do so around 4 weeks.  In your opinion, should I be concerned? Should I test? What is my risk in numbers for this instance? Can the symptoms be indicative of seroconversion, or maybe it's just a coincidence? Needless to say, I understand that since we likely had protected sex chances are in my favour. However, we did have unprotected oral sex, and just the sheer timing of the symptoms occurring (and lasting) has gotten me concerned. Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome back to the forum. Thanks for your continuing confidence in our services and your kind words.

Presumably your main concern is HIV, right? You don't actualy say whether by "I don't know his status", you mean HIV, right? Obviously I cannot judge whether the condom remained intact. You were there and I wasn't! But probably you are right that nearly all persons recognize condom failures when they occur.

Your symptoms don't really concern me in regard to HIV or other STDs. Diarrhea is rarely the initial or main symptom of acute retroviral syndrome (ARS, i.e. initial HIV infection), and as a group, your symptoms are typical for any of a number of garden variety, non-serious viral infections. Among other things, ARS or HIV do not cause cough, rhinitis, or conjunctivitis, in addition to uncommonly causing diarrhea. There is no reason to assume they have anything to do with the sexual encounter two weeks earlier. The unprotected oral sex doesn't concern me either. Oral sex transmits HIV exceedingly rarely, if ever. Finally, as we discussed in one of your past threads, the statistical likelihood of HIV in any particular straight male in the US (and most industrialzied countries) is very low.

Based on all you say, I don't think you need to worry or even to be tested. However, many persons in your situation are more reassured by negative testing than by expert opinion. If you remain concerned, consider having an HIV blood test. A standard HIV antigen-antibody (AgAb, "4th generation") detects 95% of infections 3 weeks after exposure (only a few days from now) and 100% at 6 weeks or more. While you're at it, consider routine testing for gonorrhea and chlamydia, for which you are at a lot higher risk than for HIV.

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

HHH, MD
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16 months ago
Hello Dr.  HHH, 

Thanks for an informative reply. Yes, I did refer to an HIV risk even though I forgot to state it explicitly. I figured my chosen category would speak to that. My bad. 

Few days back I got tested via a combo test and the result (today) came back negative. That's 3.5 weeks post-event, and 1.5-2 weeks after the onset of symptoms. I may retest in the future, but, as it stands, I'm not concerned as I was before. I will follow your advice and will test for gonorrhea and chlamydia as well. 

Speaking of which, I do have a point of inquiry: Is there oral vs. genital gonorrhea/chlamydia?  Is a urine test sufficient, or an oral swab is required as well/at times?  Please clarify. 

Thank you, as always. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Good point -- I wasn't focused on the question category! My bad, not yours!

The antigen-antibody (AgAb, combo, duo, 4th geeration) HIV blood tests detect almost all infections by 3.5 weeks, probably over 95%. But I'm very glad to hear you're getting mellow about all this! If you decide you need a 100% conclusive test, repeat the same test at 6 weeks. But if I were in your situation (or if you were someone close to me) I wouldn't recommend it from a medical/risk perspective, only if another negative result will help you sleep better.

Oral (actually, pharyngeal -- i.e. throat) infections with gonorrhea and chlamdia are current a hot topic in the STD research field. Pharyngeal gonorrhea is common, which has been known for 40 years. Pharyngeal chlamydia was thought to no occur or to be extremely rare, but in the last few years it has become apparent it occurs from time to time. However, it is rare; for reasons unknown, it doesn't take hold very well in the throat. (By contrast, gonorrhea bacteria are very closely related to several bacteria normal in healthy persons' throats, perhaps explaining why pharyngeal infections are common. In any case, genital or urine testing cannot detect oral infection. That said, chlamydia is so rare I wouldn't worry about it. And pharyngeal gonorrhea goes away, without treatment, in a few weeks. If all this makes you nervous, feel free to seek throat swab testing. (Gonorrhea testing includes chlamydia more or less automatically, so testing detects both.) Once again, if I (or say my daughter) were in your situation, I wouldn't hink it necessary.
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