[Question #7757] Oral exposure ARS symptom

13 days ago
Hi Dr,

18 days ago, I had vagina sex but it was protected as I wore a condom throughout. I also received unprotected fellatio and gave unprotected rimming and cunnilingus to the woman. She was late 30s, black and born in Europe. I'm also European but from a different country. She is also a mother. 

15 days post exposure, I started to suffer from joint pain and muscle aches in my arms and legs, which is still ongoing. Thinking they may be as a result of covid, I had a covid PCR test 17 days post exposure but it was negative. 

I'm quite worried that the muscle ache and joint pain could be ARS. The ache and pain remains concentrated in my legs (mainly calves, but I normally have one sore knee and sometimes my thighs are painful) and arms (elbow joints and the muscles in that vicinity). My shoulders are also stiff. 

What do you think, could this be ARS? 

Would you recommend testing? 
13 days ago
I have no fever, no rash, no sore throat etc. Only muscle ache and joint pain 
Edward W. Hook M.D.
Edward W. Hook M.D.
13 days ago
Welcome to our firm. Thanks for your question.  As long as condoms are worn from start to finish condom protected sex is essentially the risk for acquisition of STIs including HIV. In addition, there are no proven cases in which HIV has occurred as a result of receipt of fellatio, or performance of cunnilingus or anilingus with an HIV infected sexual partner.  The likelihood that you acquired HIV from the exposure you describe is extraordinarily low.

You are correct that muscle and joint aches occurring 2 to 4 weeks following and exposure are part of the symptoms of the ARS. At the same time, these symptoms,  without other accompanying symptoms are rarely part of the ARS which is most typically comprised of high fever, severe sore throat and, as you describe, muscle and joint aches.  In addition, I would point out that in scientific studies of persons seeking healthcare for a combination of muscle aches, high fever, and sore throat, less than 1% are found to have HIV. In the remainder typical, community acquired viral flu-like illnesses are the cause.

Bottom line, this was a virtually no risk exposure and the symptoms you describe, with an isolated muscle and joint aches, is most unlikely to be HIV. I would not worry. However, if my assurances do not help, if your symptoms were due to the ARS a fourth generation combination HIV antigen/antibody test would be positive at this time.

I hope this information is helpful to you. EWH
2 days ago
Hi Doctor, 

I'm now a few hous short of 30 days post exposure.

I still have slight muscle aches in my arms and legs and very minor joint pain on and off in my knees and an elbow. 

I've had no fever, no rash, no sore throat. 

I've had the joint/muscle issue since approx day 15 or day 16, so 14 days. This morning I took a rapid INSTI test which came back negative. This was 29 days post exposure - protected vaginal sex and receiving fellatio and giving cunnilingus and analingus, all unprotected. 

Considering I've had a negative INSTI test 13 or 14 days after the onset of the joint and muscle pain, is that conclusive proof that these issues are not ARS? 

Furthermore, I've had a 4th gen test at 28 days post exposure, providing a self sample via a fingerprick and sending it to the lab. I'm awaiting this result. 

1) Does a negative INSTI test 14 days after the onset of muscle/joint pain prove they're not from ARS? 

2) Was there any medical or scientific reason to even test for HIV as a result of this exposure? 

3) You say my risk was virtually zero, is this a one in many millions chance or is it NO chance? 

4) If my 28 day 4th generation test is negative, should I just put this all behind me or is the INSTI test already enough to do that? 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 days ago
Yes, you are negative test 14 days following the onset of you were symptoms is strong evidence of the symptoms are not due to HIV.  I anticipate that you’re 28 day/four week test will be negative as well. Well over 99% of person to acquire HIV will have a positive test by the time four weeks following exposure has passed.

In response to your additional questions:
1.  Yes
2.  There is a very, very small risk that, if your partner was infected and untreated, you might have acquired HIV through cunnilingus. The likelihood that that would occur however is very, very low I.e. virtually zero 
3.  Your risk of infection is largely theoretical.
4.  That would be my advice. When you were 28 day test is negative and I anticipate it will be, I would not bother to seek further testing. 

I hope the information and perspectives I have provided are useful to you. EWH
20 hours ago
Hi Doctor,

I received my 28 day 4th generation test result today - non-reactive. 

1) Would this test have definitely been positive if my muscle aches were as a result of ARS as the aches started 12 days before the test? 

2) Can I safely resume unprotected sex with my regular partner without worry? 

3) Would you regard my HIV status as conclusively negative? 

4) Is any further testing necessary? 

Thank you 
20 hours ago
Just to add

5) The blood sample for the 4th gen test was from a fingerprick and then posted to the lab. If you feel I can safely move on from this exposure, would the fingerprick rather than blood from vein change your opinion? 

Thanks again, Dr Hook 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 hours ago
As you know, we provide up to three responses to each client's questions. This is my 3rd response. therefore, following this response, the thread will be closed shortly without further responses.  Directly to your questions:
1.  Repetitive.  The answer is unchanged.  Your test would have been positive if your muscle aches were due to HIV.
2.  Yes, you can safely resume unprotected sex with your regular partner
3.  Repetitive.  The answer is still yes.  Believe your test results.
4.  More repetition.  No need for further testing.
5.  Correct. the finger prick results are just as reliable as results obtained using venous blood

This completes this thread.  EWH