[Question #7222] ARS Concern

7 months ago
Hey Doc,
I follow your site and you do a fantastic job providing fact based answers to these subjects. 
I have a few questions based somewhat on a little anxiety and fear I'm having and some just around general education on odds of infection. I had heterosexual unprotected intercourse with an old female friend/co-worker in Canada.  That was right around 4 weeks ago.  
I also then had an encounter two days ago with a female I had just met that only involved kissing and me performing oral on her.  Late last night while in bed I started noticing my neck glands starting to feel a little swollen and I was also getting a little hot and sweaty. I assume I had a small fever over night because I woke up a bit sweaty this morning as well.  Today I feel as though it has started to get somewhat better as I would now describe it as just that feeling you get when you're starting to get sick. A little warm and sweaty and the feeling that a sore throat might come on but has yet to really be sore. I have also taken my temperature a few times today and all in the normal 97-98 range. 
My fear is coming from the idea of this being ARS symptoms from the encounter 4 weeks ago as I know the oral was low risk.  I should also note that about a week or so ago(2-3 weeks post exposure)I noticed a small rash that looked like a heat rash one night on my torso area. It had been hot here and so I cooled and dried the area and by morning it was gone. I'm wondering if ARS symptoms present at different times like that? Would the rash have gone away over night if it had been? Based on these encounters and symptoms do you think testing is nessecary?  I do already have an appointment booked from before for regular bloodwork at the end of this week. I know that would put it a little over 4 weeks post exposure.. worth asking them to add HIV testing to that bloodwork?

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Welcome to the forum as a participant -- no longer just a spectator! Thanks for your kind opening words.

There is no realistic chance at all that you caught HIV from either exposure, and nearly as low a chance of any other STD. Your first partner is just about the lowest risk possible:  statistically, STDs and especially HIV are very uncommon when someone finally hooks up with an old friend that one knows well, assuming there's no particular reason to suspect s/he is at especially high risk. Furhter, HIV is rare in women in Canada, absent particular risk (injection drug use, commercial sex work, etc) -- and even in these it's uncommon. (I might worry a bit in certain geographic areas, like Vancouver's downtown eastside, and probably other similar areas.) And although your symptoms could conceivably be diue to ARS, the timing is wrong for both exposures:  too late for the first and much too early for the second:  ARS symptoms generally begin 7-14 days after infection, never earlier and rarely later. The rash you describe, although closer in timing to exposure no. 1, doesn't sound at all like an ARS rash. Finally, turning to partner no. 2, HIV has never been documented to be transmitted by either kissing or cunnilingus. 

"Do you think testing is necessary?" Depends on what you mean by "necessary". From a medical or risk standpoint, no -- testing for HIV isn't necessary. (If everyone with a history like yours ran out for an HIV test, most labs would be overhelmed and perhaps not able to handle the load, or perhaps have to quadruple their expectations!) However, most people nervous enough to come to this forum or otherwise worry need to be tested for reassurance. You would be quite unusual if this advice alone settles your fears:  most people in your situation would continue to worry and lose sleep based only on probabilities and professional opinion, no matter how expert. (We don't take it personally!) So you should be tested. At 4 weeks, an antigen-antibody (AgAb, "due", "4th generation") test would be 98% conclusive and undoubtedly reassuring -- although a second test at 6 weeks would be necessary for  truly conclusive result.

So as long as you've lined up "regular bloodwork", include an HIV AgAb test. And for additional reassurance, a syphlis blood test. Finally, in view of the unprotected vaginal sex event, a urine test for gonorrhea and chlamydia. Beyond that, i recommend against testing for any other STD. For sure there is no chance you caught herpes, viral hepatitis, or anything else that might be on your mind.

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

HHH, MD
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7 months ago
Thanks Doc,

That's was certainly helpful!

I do know this girl fairly well and she certainly is no sex worker or injection drug user(that I'm aware of). It's been a few years since we worked together and I guess I just am a little worried that she might be relatively sexual active is all.

But it turns out my already scheduled bloodwork is later today and not tomorrow as I had thought. Regardless, I am right at 4 weeks and so I will get them to add it in as 98% conclusive on top of the already low odds is reassuring... So fingers crossed.

 I also forgot to mention that I did a week of twice a day 100mg Doxycycline just after that first exposure. Would that combined with the fact I've had no symptoms down there in the 4 weeks change your thoughts on the bacterial infections?

And then lastly, I always see you say on here that chances are 1 in 2000 for a male to contract from an infected female partner and then about the same chance that a non injection drug using  female in North America would be infected.  So something like a 99.998% of it being no?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Assuming you're in the US or other industrialized country, the chance someone like this has HIV is near zero. Your statistical calculation is about right. Even among the most sexually active women, well under 1 in 1,000 have HIV. And when a woman has HIV, the transmission risk for a single episode of vaginal sex averages 1 in 2,500 (1 in 2,000 is an older estimate). So statistically, that puts your risk of HIV at no higher than 1 in 2.5 million. Looked at another way, the chance you have HIV is somewhere around 1400 times lower than your risk of dying of an accident (auto wreck, fall, drowning, etc, etc) in the next 12 months (average 1 in 1,756 annually per the National Safety Council www.nsc.org). So I would say forget HIV, but don't forget your seat belt, keep those smoke detector batteries up to date, and stay away from chain saws!

"So fingers crossed":  You can count on a negative HIV test result.

There are no medications of any kind that alter HIV AgAb test results or the reliability of the results. That includes doxycycline and other antibiotics -- not to mention immunosuppressive drugs, chemotherapy, and other nonsense you can find online.
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