[Question #8374] Please help

45 months ago

On October 3rd I had a random sexual encounter with a random female I met in the lobby. I am a 31 year old married male. I received unprotected oral sex and our genitals touched - I believe there may have been an initial insert into the vagina but only 1 time that was it.

However, I got tested 10 days after on October 13th for everything beside hiv. I was negative on everything but I did have a discharge (white) from penis on October 16th. I got prescribed doxycycline for me and my wife (who I have been active with not thinking anything came about this encounter).

My wife got a headache and low energy with a sore throat and runny nose around October 20th. There has been a cold going around so maybe that’s what caused that. However, both of us have had low energy the last few weeks. Today my dr told me I tested positive for Ebv. I think I had mono as a teen and I don’t have a sore throat. My symptoms are headache/light head/fatigue - extreme fatigue.

Do you think this could be related to hiv? My dr said I can’t test for that until 3 months past exposure.

Please help - this is stressing me out and I’m worried!

45 months ago

Also for more context -

My symptoms have been going on for almost two weeks. I wake up everyday with a massive headache and it doesn’t get better. I am extremely tired within 1-2 hours of waking up and have been going to sleep around 6 pm every night. Between all of this I have had dizziness/light head.

My wife doesn’t have the dizziness/light head but had a headache for a few days - which is now gone and has been extremely fatigued as well.

Neither of us have had any fever or rash but my wife did have runny nose/sore throat (I have not had those symptoms)

Could this all be related to Ebv? I don’t know if she had mono as a teen but I’m almost certain I did. She’s 31 as well.

All std tests that were conducted after 10 days of exposure were negative. Again - hiv wasn’t tested. They did a urine sample for chlamydia and Gonorrhea which were negative but I did have a white discharge 3 days later and had lower abdomen pressure.

Currently we’re on day 5 of doxycycline.

Really worried and looking for your expert advice.

Thank you!

45 months ago

Oh and they did find ketones in my urine when they tested it - not sure if this is related at all but wanted to add for context.

H. Hunter Handsfield, MD

45 months ago

Welcome to the forum. Thanks for your confidence in our services.

It sounds like you probably acquired nongonococcal urethritis (NGU) from the oral sex. NGU in this circumstance is believed to often result from exposure to entirely normal oral bacteria, i.e. not an STD in the usual sense. You were treated appropriately. Your wife may not have required treatment, but that was standard practice and did no harm. I'm not surprised your chlamydia and gonorrhea tests were negative: you were at no risk for chlamydia (rarely infects the oral cavity and therefore rarely transmitted by oral sex) and low risk for gonorrhea.

Aside from NGU, you have no infection acquired from the sexual event described. Testing for Epstein Barr virus (EBV) is complex, but most adults test positive on the standard, most commonly used tests. I can't say for sure you didn't acquire EBV, but it is doubtful: almost everyone acquires EBV before age 20 and then are immune to new infections. From the symptoms described, it sounds likely you and your wife both have a common cold, nothing more. (Or COVID-19, especially if you and she haven't been vaccinated.)

There is no chance of HIV in these circumstance. There has never been a proved case of HIV transmission oral to penis, and it's also very unlikely any particular "random" sexually active female has HIV. The brief genital contact, without penetration, also was no risk.

For reassurance, you probably should be tested for HIV. I stress that it would be strictly for reassurance: there is no realistic chance you have it. Also, you need testing for COVID-19. That's about a million times more likely than HIV!

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

HHH, MD

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45 months ago

Dr Handsfield,

Thank you for the reply and knowledge!

There may have been penetration ONCE - but nothing more. Our genitals were rubbing for a minute. It sounds like this is still low risk - but I will get tested asap for peace of mind.

I was tested for covid on Monday and results came in Tuesday - negative. So this has been ruled out. We are both fully vaccinated as well.

I definitely think she caught a cold with her runny nose/sore throat but very odd I have not had those symptoms. I just have had a massive headache that I can’t seem to shake and fatigue that has been unexplained. Can tell it looks like our bodies are fighting something just by looking in our eyes (circles and dull eye look)

I agree with you about Ebv. I didn’t think this was heard of at 31. Do you think the symptoms I’ve described are related at all to hiv??

Again - me: no fever, no rash, no swollen lymph nodes. Just fatigue, headache, light head, dizzy.

Wife: no fever, no rash, no swollen lymph nodes. Fatigue, (had headache for couple days and went away), not light headed, not dizzy but had the same “sick look” in her eyes.

Thank you again! Hoping for the best outcome.

H. Hunter Handsfield, MD

45 months ago

Actually, it's not at all odd that your partner has a cold and you don't have symptoms. Whenever a common cold is circulating, roughly half of exposed persons either don't catch it, or they are infected without symptoms. And you describe no symptoms suggestive of acute HIV, which doesn't cause nasal congestion, for example, and unlikely to cause dizziness or light headedness. And as already noted, you really weren't at measurable risk of HIV. If somehow I were in your situation, I wouldn't even be tested for it. But assuming you go ahead with testing, you can have a conclusive HIV AgAb (4th generation) result at 6 weeks -- or at 4 weeks (i.e. now) for a 98-99% conclusive result.---

45 months ago

Thank you Dr. Handsfield!

Last question/confirmation -

1. Do you think the Ebv testing is related at all to hiv?

2. Are you confident I do not have/acquired?

3. What could cause the extreme fatigue/headache? Aren’t these symptoms of hiv? I know they are also symptoms of a lot of other things as well but it’s odd timing and the fact that we both have/had those symptoms.

4. Would there be other symptoms along with what we are experiencing or can these be stand alone symptoms that can be hiv positive?

Thank you again! I know this is the last follow up. I truly appreciate your advice and this forum!

45 months ago

Also - what do you think it could be?

H. Hunter Handsfield, MD

45 months ago

1. No. You already understand you probably have had EBV for years. How could it be related to HIV from your recent low risk exposure?

2. In the 15+ years of this and our preceding forum, with thousands of questions from persons worried they might have HIV, not one has yet reported they tested positive. You won't be the first. If and when that happens, undoubtedly it will be an obviously high risk exposure (e.g. unprotected anal sex between men, known infected partner, etc) -- and not a trivial no risk event like yours. Can I be 100% certain you don't have it? Maybe not quite -- I'd be OK with a guesstimate of one chance in several billion you have HIV. But no higher than that -- i.e. zero for all practical purposes.

3. There must be a hundred causes of such symptoms. HIV is a rare one. The best bets probably are the same virus causing your partner's cold; or emotional/psychological because of the anxieties obvious in your questions.

4. Almost everybody with symptomatic acute HIV infection has various combinations of fever, sore throat, body-wide enlarged/inflamed lymph nodes, and/or a diffuse, non-itchy skin rash.

Do your best to accept the science based reassurance you have had and don't overthink it. You don't have HIV. Believe it and move on!

That concludes this thread. Best wishes and stay safe.

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45 months ago

Thank you Dr Handsfield.

My Dr confirmed Ebv level at 97 - he said 4 times the normal amount. Antigen was 77.

I read somewhere online that Ebv levels spike during an acute hiv infection. Is this true?

I have slight yellowing in the whites of my eyes. Circles under eyes and extremely exhausted still. Headache is gone! Still no fever, rash, sore throat or swollen lymph nodes. Maybe I do have Ebv and that’s what’s causing this?

45 months ago

Also - yellowing is a slight yellowing.

H. Hunter Handsfield, MD

45 months ago

I have nothing more to say about your symptoms; those related to your eyes don't suggest anything serious. It is pointless to speculate and worry about HIV without having been tested: the expected negative result will reassure you far beyond my ability to do so. I'm not sufficiently familiar with EBV diagnosis to comment further, except to reassure you that it does not imply you have recently acquired HIV. You should discuss all this, including your HIV fears, with your doctor. If s/he doesn't seem to be on top of it and/or cannot answer your questions about it, ask for consultation with an infectious diseases specialist.

That completes the third follow-up comment/question cycle (normally we stop after two) and this thread will now be closed. I hope the discussion has been helpful. Best wishes and stay safe.

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