[Question #7208] ARS or STI symptoms?

5 months ago
Hello Doctors,Thank you for your services! So thankful to be able to reach out and ask you questions. It's been a frightening few days and I'm reaching out in hopes your professional opinions can ease the nerves and help me with what to do next. Will try and keep it short and detailed. Location- cheap massage parlor in Seoul Korea and paid $100Exposure- Thai or Philippine csw female possibly post op trans..not sure....she had a vagina and no penis.Engaged in condom sex for about 20 minutes and then unprotected oral ( give and receive ) for about 10 minutes til finish for me.I'm sure the condom was on for all activities except for the oral since I took it off myself when oral began. Drank that night but in hindsight my fears are that the CSW was a trans post op and her being very very thin might be due to her being HIV/Aids status. Date of exposure- 8/7/20Symptoms- 8/22/20 start to feel flu like symptoms coming on. Chills, achy, tired.8/23 through 8/28 ( today)- -Bad headaches -Throat tight and sore, lymph nodes on side of neck feel tender.-Sun burnt skin and prickly sensation.-Reddish skin with tiny bumps everywhere ( like goose bumps ) from shoulders, stomach, to waist. Semi itchy and when I scratch the bumps it turns red. -Nausea comes and goes-Inner ears hurt and feels pressure-Loss of appetite-Tingling at tip of penis -98.9 is highest fever ( run normally at 97.5 for me )- Constantly tired and malaise-Mouth and lips tingle but no visible outbreak of any kindTests-Feared Covid at first and took Sophia and PCR tests and both came back negative 8/26.Took Oraquick home swab test and negative ( I know that it's too early but did it to ease my mind ).I've read the posts where receiving fellatio or giving cunningulus unprotected regardless of hiv status is considered to be close to or at zero possibility? Trouble you for your expert opinion on my symptoms and if your thoughts on risk of exposure?  Thank you!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome to the forum. Thanks for your confidence in our services.

First, you had a pretty low risk exposure. Condoms work very effectively in preventing HIV transmission by vaginal sex, and you are correct that oral sex -- both oral to penis and cunnilingus (oral-vaginal) -- are basically risk free in regard to HIV. Second, your negative Oraquick test is quite reassuring. You're right that it was too soon to exclude HIV with certainty, but it IS conclusive that your symptoms are not due to ARS. The symptoms of ARS are caused by the immune response to the virus -- and therefore it is rare to have HIV symptoms with a negative antibody test. In addition, the symptoms started quite late:  ARS symptoms usually start 8-10 days after infection; your onset at a little over 2 weeks doesn't conclusively exclude ARS, but reduces the likelihood. You should follow through with proper testing. You can have a nearly conclusive antigen-antibody (AgAb, "duo", "4th generation") blood test 4 weeks after the sexual exposure -- about a week from now -- and a truly conclusive one at 6 weeks. I'm confident the results will be negative. (But do not rely on Oraquick, which takes 3 months to nearly conclusive results, and some HIV infected persons never develop positive oral fluids tests.)

As for the symptoms themselves, they really aren't typical for ARS. Certainly such symptoms could occur, but the combination of symptoms you describe really don't sound like it. And you do not have fever. Body temperature varies over the course of the day; 98.6 is the average, with everybody having some readings as low as 97.0 and as high as 99 or even 99.5. Your result of 98.9 isn't nearly enough to be suspicious for ARS.

As for other STDs, your symptoms don't fit at all. Based on those symptoms and the exposure history, I don't recommend testing for any other STDs.

In view of the pandemic, you were right to be concerned about COVID-19, and I'm glad to hear of that negative result. (However, I don't know the term "Sophia" in regard to coronavirus testing. Is that a typo? Or maybe an antigen or antibody test?) As you may know -- there's been a lot of media coverage -- the COVID PCR tests miss many infections, and antibody testing doesn't typically become positive until 3-4 weeks. So you might need retesting. In any case, if your symptoms continue, see a doctor for personal evaluation.

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

HHH, MD
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5 months ago
Dr. Handsfield,

Thank you for your time and expert opinion. I feel so much better after reading your reply. 

I will follow through with the proper testing that you mentioned at week 4 for piece of mind and week 6 if my anxiety hasn't subsided by then. 

As for the Covid testing, the Sophia test was the antigen test. I did have concerns of 2 false negatives and still think maybe that's a possibility at this time with all the discussion of accuracy for Covid testing.

And with the symptoms not fitting any other STI descriptions as you state, I can let out a big sigh of relief. 

I can't thank you and everybody there enough for being available to me those like me. I'm sure the thousands of people you've helped over the years are all grateful as I am.

Thank you and best wishes!!



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Thanks for the thanks; I'm glad to have helped.

You could consider seeking out a COVID-19 antibody test ~4 weeks after the date symptoms began.
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5 months ago
Will do! Thank you Dr. Handsfield!
5 months ago
Hello Dr. Handsfield,
I've been waiting till now,  the 6 week mark ( today is day 42 ) to get the 4th gen test so I could have 100% piece of mind with the results when they come out and move past this.  Earliest I can get to testing center is Monday.  But I did have a question that I'm hoping you can help with. Earlier this week, my GP took another swab test for Covid ( 3rd swab negative ) and a blood ab igg test for Covid ( positive abnormal ) and states "results suggest recent or prior infection with sars-cov-2". 
Blood work shows the following ranges:
wbc- 8.5 and range is 3.4 - 10.8
rbc- 5.35 and range is 4.14-5.80
platelets- 12.5 and range is 11.6 -15.4
Neut (absolute ) - 5.9 and range is 1.4-7.0
Lymph ( absolute)- 1.8 and range is 0 .7-3.1
Monocylte(absolute)-0 .5 and range is 0.1-0.9
Eos(absolute) 0.3 and range is 0.0-0.4
My symptoms still today are weak and achy muscles, sore joints, painful burnt skin feeling, bloated upset stomach, stiff neck with swollen feeling and pressure under jaws and both sides of throat. Lymph nodes in neck tender but no painful...just the neck and jaw area feels very swollen. Lymph node in left armpit tender. Rash is gone and all symptoms greatly improved but not gone in last week. 
My question is this....with the blood work report, the positive abnormal ab igg covid blood test, and my symptoms still present at week 6, is it safe to think this is all covid related? Wouldn't my counts be out of normal range if I truly was hiv infected? But then again, wouldn't my wbc and rbc be off if I truly am fighting Covid? When I take the 4th gen test over the weekend, I look forward to the results but will also be very anxious until the results are in. Trying to ease my nerves until then and hoping your expert opinion can help.
Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Thanks for the follow-up. This forum being limited to STDs, COVID-19 is off topic -- so only brief comments/replies.

Most of the available antibody tests for SARS-Cov2 are accurate, and your doctor is correct that your positive result indicates recent COVID-19, despite your negative PCR test. As innumerable news stories have reported, many people have long recovery periods; symptoms like yours for several weeks are very common. You can expect them to gradually resolve. If they continue, stay in touch with your personal physician.

Aside from that antibdooy test, the blood work you report is entirely normal, which is often the case witih COVID-19. There's nothing unusual about that. Many or most viral infections cause no blood count abnormalities.

So I'm glad you followed through with coronavirus testing and glad to hear you're recovering from it. For the reasons we discussed earlier, you definitely can expect your 6 week HIV AgAb test to be negative. No more comments or discussion until then, after which this thread will be closed.
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