Hope you are well.  

I posted a question a few weeks ago about an oral exposure where I mentioned that I received and performed oral sex on another male ( my first and only time), who subsequently turned out to be potentially high(er) risk, often partaking regular anonymous sex.    

I have subsequently tested negative for  any UTI, Gonn, and Chlamydia with both Urine and Throat Swab at just over 2 weeks post event.  

I mentioned in my question that at 15 days post encounter that I was experiencing Nausea, a slight temperature and an upset stomach (quite watery diarrhea) which has now persisted for 17 days which will is not responding to any treatment or dietary changes.  

The reported temperature of 37.1 degrees celsius in my initial question is now reading anywhere between 36.4 and 36.8, so very normal. 

I am still concerned with the diarrhea as it is most unusual for me and I have had no contact with other people due to covid restrictions.    

I am due to have an HIV and syphilis blood test next week but I am very worried about this exposure. 

Do you think this may be indicative of ARS at all?   Would this concern you from a sexual health viewpoint? 

Thank you in advance for your answers. 

Your symptoms are not at all suggestive of ARS. It can be alarming to read lists of symptoms that can occur with ARS; almost any symptom associated with any common, trivial infection also can occur with ARS. The individual symptoms are much less important than the pattern of symptoms: timing, combinations of symptoms, severity, and others. When ARS causes symptoms at all (often it does not), they usually include sore throat, fever, skin rash, and enlarged lymph nodes. Diarrhea is common, but rarely if ever the main or only symptom. Your entirely normal temperature is strong evidence against ARS as well. And as discussed with Dr. Hook, you had a very low risk exposure for HIV. As he advised, there has never been a proved case of HIV transmission oral to penis; and in the other diretion (penile to oral) it's rare -- with an estimate from CDC putting the risk at 1 chance in 10,000, and that's only if the penile partner is known to be infected. That's equivalent to performing BJs on infected men once daily for 27 years (divide 10,000 by 365) before infection might be likely. And you don't know your partner was infected.

There are two paths to resolving this immediately, without waiting for your planned HIV test next week. 1) Get tested now:  a negative result would prove 100% that HIV isn't the cause of your symptoms; it isn't possible to have ARS symptoms more than 3-4 days and not have detectable HIV antibody. You'd still need another test -- ideally 6 weeks after the exposure, when an AgAb (duo, "4th generation") test would be 100% conclusive. 2) If you're in touch with your partner, ask him. If he knows he is HIV negative -- or if positive is taking effecive anti-HIV treatment -- you'll know you were not possibly infected.

So what IS causing your symptoms? Any number of infections, mostly mild, are considerations. But continuous diarrhea for 2 weeks deserves medical attention. Are you confident there was no opportunity for fecal exposure during your sexual exposure? A number of intestinal infections are "occupational" hazards among MSM, but not likely to be transmitted by fellatio, either giving or receiving. Beyond that, there simply are too many possibilities to make even an educated guiess. In any case, it makes sense to see your doctor about your intestinal symptoms and take it from there.

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

HHH, MD

The only possibility of that would be fecal matter on his penis from a previous meeting immediatley prior to meeting me, which is not entirely unlikely given what I now know about his other activities.   

This has been my only sexual exposure since my last set of tests last year and my only experience with another male to date.   The encounter consisted of only of  penile/oral and no anilingus was performed or received by myself.   It was a 5- 10 minute encounter at most.    

No-one else around me at home has been sick or had a similar stomach upset and I really can't think of where I would have picked something up. 

I have a scheduled appointment with my GP regarding the stomach upset in the next few days where I will ask if blood work can be performed for HIV.   This appointment happens to be more than 28 days after the event.   

I performed a home/finger prick antibody only test at 16 days post exposure and 6 days after the onset of the diarrhea and nausea, which was negative, but I am aware that this is meaningless at this stage.    

I already have a test at a GUM clinic booked for 6 weeks after the exposure which I will keep for a further HIV and Syphilis test.   

I can use my last follow up question to let you know the result of the tests either way, should you wish to know them? 

Thanks again for listening and for your answers. 

If you're not confident your GP is up to speed on intestinal infections and especially such infections in MSM, the NHS GUM clinic would be an excellent resource. You can be sure they're on top of these issues.

Threads normally are closed after two follow-up exchanges, but I'll leave this open for you to let me know the outcome of your GI/diarrhea evaluation, but I'll have nothing more to say until then. There won't be a need following your 6 week HIV and syphilis tests. They will be negative.