[Question #8200] Follow up question: new exposure

47 months ago

I had asked a question before. I want to bring up a new exposure. As you recall my ex had tested negative for HIV on 8/1. He was negative. I met up with him on 8/24 and 8/26 and performed unprotected fellatio on both days. The first day i was coughing a lot and took a lozenge so it was hard for him to get up. It was a lot of resting and then it ended. On 8/26, it was a full session but I didn’t let him ejaculate in my mouth.

Anyway, he ended up telling me later on that the prior week he had spent with a girl that came to New York to visit him from London that he is pursuing a relationship with. They spent the week having sex unprotected. This obviously worried me. He told me that she got tested before coming but I don’t know how true that is or if he just told me that to put my mind at ease.

A week after the second exposure, I had a migraine for 2 days that went away after taking sumatriptan and a sore throat that started around that day too and I still have. Mostly sore when I swallow but probably a 4 or 5 out of 10 as far as pain is concerned. Yesterday on 9/4, I noticed a new swollen lymph node on my neck and then had soft stool when I woke up today. My skin does feel warm/hot to the touch but I don’t have a thermometer and I don’t feel feverish. I have a few questions:

1. Do you think that I should get a 4th gen test at 14 days post second exposure? I have read that you said that if symptoms are due to ARS, then the test will be positive regardless of when it’s taken. How conclusive will the test be at this point? Would an RNA be a better option and if so would it be conclusive at 14 days? I want to put my mind at ease and the waiting game is hard for me.

2. Do you think these symptoms can be ARS related? Is the timing ARS related? The sore throat and headache started 7 days post 2nd exposure and 9 days post 1st.

47 months ago

3. As far as the lymph node on the neck is concerned. It’s fairly small probably less than a centimeter and it’s the only one I have so far. Is this part of ARS or is ARS usually in multiple places and bigger lymph nodes?

4. I know I see everywhere they giving blow jobs are very low risk, close to zero but not impossible, have you had or know of patients personal to that have acquired this way?

Thank you again for all your help.

H. Hunter Handsfield, MD

47 months ago

Welcome back, but I'm sorry you found it necessary, especially since we discussed the low risk of HIV from oral sex during the thread that was closed a couple weeks ago. I know there's a health-worry component, but I think you also need to understand how rare heterosexually transmitted HIV is and the extremely low risk for the large majority of sexually active single people. The large majority of HIV transmitted sexually between men and women is in the regular partners of people at obvious high risk (although sometimes unrecognized risk): the wife who doesn't know her husband is having frequent same-sex exposures, the partner of a closeted injection drug user, and so on. Almost no persons in your circumstance should be worried about HIV or should be tested after any single exposure. Assuming your ex dates only women and isn't an injection drug user, you can be very confident that sex with him is entirely safe. And there is always zero risk of HIV (or close to it) for oral sex.

On top of that, you had only condom protected oral sex! That makes HIV absolutely impossible. Further, your symptoms do not even hint at HIV.

Those comments pretty well cover things, but to explicitly address your questions: 1) I recommend you not be tested for HIV at all. 2). Your symptoms and timing are consistent with ARS, but that is irrelevant and they do not suggest HIV. It is far more likely you have any number of garden variety viral upper respiratory infections, allergy, etc. 3) ARS would never cause a single lymph node to be inflamed, and anyway such a small bump doesn't even sound abnormal. 4) No, I have never had (or heard of) a patient in your circumstances who acquired HIV.

Do your best to move on without further worry. My final advice is to stop worrying entirely about any individual exposures, unless or until you start having unprotected vaginal (or anal) sex with bisexual men or other particularly high risk individuals. Instead of obsessing about individual events, take the approach of the vast majority of single persons: as long as you're having sex at all, have an HIV test (and tests for other common STDs) once a year.

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

HHH, MD

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47 months ago

Hi doctor, thank you so much for your response. Just to clarify, the oral sex I performed wasn’t with a condom, it was unprotected.

And just some clarification on you end, are my symptoms consistent with HIV? You said in one part that they don’t hint at hiv and on the other you said that the symptoms and timing were consistent with ARS.

Also since I was coughing a lot already when I was with him and possibly had something happening in my throat, would a cold or viral infection of the throat up the chances?

Sorry for all the anxiety but my ex just lies a lot and the timing of the sore throat and lymph node aren’t helping.

Thank you again.

H. Hunter Handsfield, MD

47 months ago

The presence of any symptoms of HIV do not hint at it because HIV is such a rare cause: the chance of something else is astronomically higher. Anyway, typical ARS also includes fever, skin rash, and multiple enlarged nodes, not just one; and does not include cough. We have discussed the near-zero risk of HIV by oral sex, including unprotected. And no, having a cold or cough at the time of exposure is not known to elevate the risk of HIV. Also please note all the other reasons that argue against HIV risk.

You needn't apologize for being anxious, but you cannot talk me into believing there is any chance at all that you have HIV. You came here for our reassurance, presumably, yet you're choosing to ignore all I have said. You're just going to have to either ignore or accept my expertise and reassurance as you wish, but this isn't a debate! If you were convinced you were at risk or might be infected, what was the point of posting? Of course you are free to be tested if you insist -- but I'll never recommend it.

Sorry if this sounds more direct or condescending than you were expecting, but that's where I stand. Call it tough love if you wish!

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47 months ago

Hi doctor,

Thank you so much for the reassurance. Just a few last questions and forgive me if they’re stupid:

1. In the off chance that this new partner could have infected my ex when he was with her a week before, would the fact that it would be a recent infection and he would be most infectious during this time, up the chances or statistics of acquiring through oral?

2. Does ARS cause a sore throat that comes and goes or would it be persistent throughout and then go away?

3. Is the fact my migraine only lasted first 2 days even though my sore throat has persisted for 4 days after, consistent with ARS?

4. I felt a lump in my vulva that my gyno said feels like a cyst that isn’t abnormal, is this something consistent with ARS? Is spotting between periods ARS?

5. I felt pain in a my groin area, not sure if a lymph node, I’m pretty thin so usually feeling lymph nodes in my groin is normal for me so not sure if swollen or not. Are ARS related lymph node swelling tender?

6. Could my sore throat be caused by a different STD?

I am aware this is my last follow up. Thank you again and thank you for everything that you do!

47 months ago

7. Also assuming that I have had a sore throat for almost a week and I haven’t had any other of the usual ARS symptoms as of yet, if any other symptoms do creep up can I assume they aren’t related due to them not beginning at the same time?

H. Hunter Handsfield, MD

47 months ago

1) This scenario is too unlikely to be taken seriously. In that hypothetical situation, there could have been risk for HIV. But you can be sure it didn't happen.

2) The sore throat would continue unchanged for a couple of weeks. It would not cause pain on and off.

3) Migraine is not a symptom of ARS.

4) No, such a cyst or lump would not be caused by ARS.

5) ARS also never causes localized lymph node inflammation in only one site, and it does not cause groin pain.

6) Sore throat is rarely a symptom of any STD.

7) Yes. You can safely assume any additional symptoms you experience from here on out are not due to ARS. It would be different if you had had a significantly risky exposure, but you did not!

Do your best to move on without worry. Let me remind you that your first thread started with this: "Let me start by saying that I am a major hypochondriac and deal with anxiety a lot so not sure if that anxiety are to blame for my symptoms." Whenever someone suspects his or her own symptoms have a psychological origin, usually s/he is right.

That concludes this thread. Let's make it your last about these or similar events. All is well: do your best to move on without worry!

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