[Question #6461] Unprotected oral sex & symptoms 1-3 weeks later and still ongoing: very anxious

Avatar photo
67 months ago
  • brief, unprotected receptive oral sex (giving oral sex) on 12 December to male CSW in London.  No other sexual activity.  
  • he confirmed he was negative & recently tested a few weeks before (my concern is he could have contracted during the previous couple of weeks & therefore had high viral load). 
  • no ejaculation and I did not sense any pre-ejaculate.
  • I had minor cold/nasal congestion the week before.
  • I had all-over muscle aches & headache upon waking up on 20 December.
  • I have kept waking up with bad headaches every morning from 20 December to 27 December and had muscle aches in legs.
  • on 26 December I noticed a small "spot"/"lump" on the left side of the back of my head; looks like it is exactly where one of the occipital lymph nodes is located.  Not sure if swollen lymph node or just spot/bite/irritation - it is extremely small and tender to touch; like a typical acne spot.  As far as I am aware, no other lymph nodes are swollen but even when I'm ill they don't usually swell up so who knows if they actually are infected.
  • I've been taking my temperature regularly since 20 December.  Never been higher than c. 37.5 and usually is  36.5 however I usually run around 36.5 so maybe have had low grade fever on occasion.
  • Most concerning symptoms of all and the ones that have pushed me into an anxiety-driven mess ...... on the night of 28 December, and on-and-off every night since then, I have been waking up in the middle of the night with night sweats.  Not "drenching" ones but my sheets are very damp.  NO fever recorded.  Also, minor sore throat has arisen in last few days on left side only.
  • I know only way to be sure is to test but currently travelling in Asia so any reassurance or risk assessment based on above appreciated before I return to UK to test in 2 weeks time.

Avatar photo
Edward W. Hook M.D.
67 months ago

Welcome to the Forum and thanks for your question.  From reading your question, my sense is that the only thing that will really resolve your concerns is a test and I would urge you to do so when possible.  I hope that the information below will help to reduce your concern however.

You suggest that perhaps your partner had become infected in the interval since his last test.  I would remind you however that since I suspect that he was a CSW for some time, having avoided infection to date makes it likely he will continue to do so. Further and parenthetically, for future partners, you might also ask them if they are taking PrEP since it is widely available and a male CSW would be a reasonable person to take it, given the occupational risk. 

The exposure you describe was low risk, even if he had HIV.  The risk of acquiring HIV from performing oral sex on an infected partner is, on average, less than in in 10,000.  Thus, even if he was infected, your statistical risk low and chances are, on average, 99.99% that you would not be infected. 

Finally, while the timing of your flu-like illness does coincide with the time that the ARS might occur, it does not have all of the features of the ARS and, even if it did, it would be far more likely that you acquired a typical, influenza-type, non-STI viral illness than HIV.  The classical ARS include HIGH fevers (yours are not) and a severe sore throat as well as muscle an joint aches..

Bottom line, your risk for infection is quite small.  Nonetheless, I think testing is reasonable.  If your current illness is HIV a HIV PCR test will be positive at anytime more than 11-12 days after exposure and a 4th generation, combination HIV antigen/antibody test will be more than 99% reliable at 4 weeks.

I hope this information is helpful.  EWH

---
Avatar photo
67 months ago
Okay, thanks.  I wouldn't call my symptoms necessarily "flu like" as they are fairly minor.  A few follow-ups:

(1) Would ARS usually manifest itself with different symptoms appearing at different times or would they usually all hit at once?

(2) Is a single enlarged lymph node (if that is what the spot on the back of my head is) indicative of ARS when considered together with my other symptoms and exposure?

(3) There seem to be very few causes of night sweats and Dr. Google always returns HIV; hence my incredibly increased anxiety since these started.  Are these usually fully body and accompanied by fever when seen with ARS?  I am very concerned and the stress is no doubt making me worse.

Avatar photo
67 months ago
Also, if these symptoms were ARS would a regular antibody test return a positive result by now or would I need a combi antigen/antibody test?
Avatar photo
Edward W. Hook M.D.
67 months ago

thanks for your follow-up questions- they are good ones.

1. When the ARS occurs, symptoms are typically rather severe and all occur at about the same time.

2.  A solitary lymph node is highly non-specific and would be quite unusual in the ARS.

3.  I urge you to stay away from Google for this purpose.  As you have experienced, most any sign or symptom looked at on Google will have HIV listed as a potential cause.  Much of what is there is either out of date, taken out of context or just plain wrong.  Night sweats are non-specific.  Common causes include gastric reflux and just about anything that can cause a viral sore throat.

Particularly for early diagnosis of HIV symptoms a combined HIV antigen/antibody test is better and provides more accurate results than antibody only tests.  They are widely available at most places where HIV testing is performed.  EWH

---