[Question #6651] Negative Oraquick but non-stop symptoms

13 months ago
Hello doctors,

I asked a question 9 months ago after I suspected getting HSV from oral sex but Terri promptly reassured me and indeed I tested negative for herpes.
Now my mind has shifted to HIV and I am extremely scared.

Recap of the situation: end of May 2019 I received oral sex from a CSW. I didn't notice any blood or sores in her mouth, just lots of saliva.
4 days later I started feeling a tingle in my scrotum, and the next day I had fever and chills for 24 hours.
This subsided but the week after I started having backache and nerve/muscle pain down the left leg for about 2 weeks.
I never suspected HIV due to the assumption that oral was safe for that, but 3 months later (end of August 2019) I started having muscle spasms and a pins and needles feeling in my feet and hands. This lasted a couple of months ad subsided around Christmas. Once it started subsiding I developed a burning sensation in my mouth (tongue and roof) - maybe thrush but the mouth looks normal in appearance and it does not hurt when I eat or drink (even spicy food). I am also having recurrent headaches and psoriasis on my elbows.
Because of that I took an Oraquick oral swab 7 months after that exposure: NEGATIVE.

I am very conflicted:
On one hand I had just oral sex, I had symptoms starting very early for being HIV (fever at 5 days, that's why I though HSV at first) and a negative Oraquick at 7 months.
On the other hand all this pins and needles, burning mouth, headaches and psoriasis seem to be pointing directly to HIV.

How likely it is that the Oraquick missed my infection? Do you recommend further testing in light of these symptoms?

Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome back to the forum. Thanks for your continued confidence in our services. I was logged in when your question arrived:  most questions don't have nearly real-time replies!

Oral sex is risk free for HIV. There has never been a proved HIV transmission mouth to penis. In addition, your symptoms are not suggestive of HIV. Finally, the negative oral swab HIV test shows you weren't infected.

That said, Oraquick misses 1-2% of HIV infections. If you want a truly conclusive test, have a blood test. Because there is no chance you have HIV, I'm sure it will be negative, and if I were in your situation I would accept the result you already have. (I would not have even been HIV tested.) But if you feel you need a 100% conclusive result, you'll need to do the blood test. This is strictly for reassurance, not because of your exposure or your symptoms. It's up to you.

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

HHH, MD
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13 months ago
Hello Doctor HHH,

Thanks a lot for the real-time answer and the reassurance, it's extremely appreciated.

Actually one of the reasons why I decided to post here (despite the numerous online forums and websites available for free) was to have the opinion and the reassurance of a top MD on my situation.

I am curious as to why you said that my symptoms are not suggestive of HIV?
From what I could read online, pins and needles in extremities, white tongue and mouth burning are signs of a virus present in the body and many websites state that they are typical of HIV infections.

Another question I had was in regard of my short flu-like fever (accompanied by chills) 5 days after the event: I am sure it is related to the exposure, I am the type of person who never gets sick and I haven't had a fever in nearly a decade. Yet 5 days after that episode I had one.
What gives me hope is that it started very soon - 5 days as I said - and was very short: I went to bed with it and the next morning I woke up feeling OK and able to go to work.

Do you think it is remotely possible for it to be ARS fever? If not, could any other STDs cause it?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
I glossed over your symptoms because the test results are so good that they always overrule both symptoms and exposure history. No matter how typical of ARS someone's symptoms might be, and no matter how high the risk at the time of exposure, the test results are to be trusted and believed. In addition, ALL symptoms of ARS are common to a large number of other medical conditions, mostly much more common than ARS. Thus, even the most typical symptoms rarely are due to ARS, even in people at high risk for a new HIV infection.

That said, it is also true that your symptoms simply are not very typical of ARS. Let me count the ways. "Spasms", "pins and needles", "nerve pain back of leg"? Conceivably HIV neuropathy, but that's a problem of advanced HIV (i.e. AIDS), not ARS. "Burning sensation" in the mouth? Not sufficient to suspect oral yeast infection (thrush), and in any case, thrush also is a problem primarily in AIDS, not ARS. Headaches and psoriasis also do not suggest HIV. Your earliest symptoms at 4 days were too soon; ARS cannot cause symptoms sooner than 7 and usually 10 days after infection. The only symptom you do mention that is common in ARS is fever, but the fever of ARS lasts for days, not 24 hours. Most improtant, you never describe anything like the typical symptoms of ARS, typically a combination of sore throat, fever, enlarged lymph nodes in several areas of the body, and skin rash, all starting about 10 days after exposure and lasting 2-4 weeks.

Bottom line:  Even if you had typcial symptoms of ARS, the test result proves they were caused by something else. And your symptoms definitely were not typcal.

Do I thin it is "remotely possible" you have or had ARS? Absolutely not. Other STDs? Also absolutely not; no STDs cause any of the things you describe. If some of them are connected to the sexual exposure you are worried about, it is psychological -- i.e. your fears and anxiety magnifying unrelated symptoms or normal body sensations that you otherwise would ignore, or not even notice. But for sure not from any infection from that event.

Trust me on this:  You do not have HIV or any other STD from that event. Believe it and move on without further worry.
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13 months ago
Thanks again Doctor for the additional reassurance.
I will try to move on with confidence that I won't put future partners at risk.

As a final follow-up, I would like to ask one more question: my pins and needles (perhaps neuropathy), mouth burning (perhaps oral thrush) and headaches did not occur shortly after the event, but rather 5-6 months after it.

Would that change your assessment?

Thanks again for the incredible service you offer through this platform, it was a pleasure and a privilege to interact with you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
And if you understood my comments above, you know the answer:  since your negative tests override symptoms, any further detail about your symptoms cannot change my opinion or advice. Anyway, hose symptoms do NOT suggest thrush or anything else associated with ARS or HIV. 

Thanks for the thanks. I'm glad to have helped.
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