Thank you for this service.  A brief update on my last question some months ago....turns out no STI but lyme disease causing fevers. All is well now.  Getting into a knowledgeable MD was a life saver.

current concern....I am a male, gave a male unprotected oral sex.  There was no ejaculate but it lasted 20 min. or so off and on.  I did try condom protected frottage on my bottom but no pentration and that is not the risk I am concerned about.  18 days post the event I got chilled, ran a fever of 99, body aches, head ache and some stuffy nose, drainge, almost feels like sinus but also the flu.  No rash.  No sore throat.  I have not had a flu shot. I have tested 3 x for covid on rapid, all negative.  I am very concerned this is ARS.  I have tried to contact the guy and he said he was tested in Oct of this year (good) but does have two regular guys he sees, one he doesnt use protectoin with (concerning).   I have read all the previous post and feel confident that I did not likely catch HIV from this event.  But the word, "likely" is what is concerning me with these symptoms.  My thought was to order both a DNA HIV Test for tomorrow and an duo HIV test.  Assuming at 20 days (tomorrow) the duo would likely pick up an infection with symptoms and the DNA certaintly would at 20 days.

My questions:

1.  Does this sound like ARS?

2.  If I were your patient, would you recommend testing because you were concerned or you knew it would easy my mind?

3.  What does real, theorhetical, rare all mean when talking about catching HIV by giving oral sex?

4.  Would you recommend these tests for peace of mind?  I know that there is a chance the DNA could be a false positive and I assume the duo would pick up if symptoms?

Thank you.

These encounter you describe was very low risk for acquisition of STI’s, including HIV.  If your partner had HIV and from what you say that appears unlikely, your risk of acquiring infection from him by performing oral sex on him is less than one infection per 10,000 encounters. In other words, chances are 0.99% that you did not require HIV In the unlikely circumstance that he was infected. In addition, if there was only anal frottage without penetration this to was an entirely no risk event for HIV acquisition.  The term ARS stands for acute respiratory syndrome. In the medical field a syndrome is a collection of symptoms which has multiple possible causes.  The constituents of the ARS typically include high fever, severe sore throat as well as muscle or joint aches and on some occasions a rash.  Sinus symptoms are not part of the ARS and the absence of a sore throat or high fever make it still more unlikely that your current problems are the ARS. Rather it is likely that you acquired one of the every day respiratory illnesses that people tend to get around this time of year. You did well to test for Covid and I’m glad that it your results are negative. After three tests you can be confident in those results. On the other hand there is a long list of other viral illnesses including influenza which can cause the symptoms and her for more likely to be causing the symptoms you describe.

Verse, in response to your specific questions:

1.  No

2.  Personally I see no scientific reason for testing however if it would ease your mind there is no reason not to test. If your symptoms are due to HIV, a fourth generation combination HIV antigen/antibody test would be positive at this time. There is no need for an HIV PCR.

3.  Please see the statistics I provided above.

4.  Repetitive and already answered.

I hope this information is helpful. As I answered this question and reviewed your to earlier interactions with Dr. Handsfield, it appears to me that you are quite concerned about the possibility of acquiring HIV. If that is the case, you might consider discussing with your health care provider taking HIV preexposure prophylaxis (PrEP) which would virtually eliminate any risk for HIV acquisition. EWH

Doctors,

Thank you for the prompt feedback.  I think I know the answer to my question but I wanted to provide a follow up given it might help someone else. 

The advice given was reassuring.  I decided against doing online testing and went to see an ID specialist that happened to have open appointments as a work in.  I discussed the risk.  He concurred it is highly unlikely to be ARS and he did do a flu and repeat covid test, which was negative.  I dont think he believed my anal frottage story for he harped on it but it was the truth.  I guess it almost penetrated but covered and never really did, only pushed up against my anus.  We talked about prep, which i have an appointment for Feb. to discuss further.  He treated this appointment as just dealing with these symptoms and getting a baseline.  He preformed a combo antigen/antibody test and PCR.  I got called a week later and told both are non-reactive.   I spoke to the nurse.  She said that given it was 20 days since exposure, the antibody test would pick up a lot of positives but did not give me a percentage.  She said the PCR is as close to 100% proof as i can get showing I did not have HIV.  I asked her about the tests positive if this was ARS and she simply had no idea what I was talking about and told me I could talk to the doctor during my feb. appointment.  So my questions. 

1. I assume that the nurse is right that the PCR test proves this event is not something to worry about?

2. Just confirming for all readers, this website service basically states the risk was low, a combo test would be positive if this was ARS and adding a PCR, I assume this is 100% proof i am negative when you add the low risk and two tests (combo/pcr) at 20 days together?

3. Neither the nurse or doctor said anything about retesting at a later date so I assume I do not need any further testing?

3.  We did not talk a great deal about prep at this appointment, it was focused on this exposure and all real discussion about prep punted to February.  While he seemed not to believe my frottage story, he did seem to think i was low risk given oral was my primary act and anal was rare and always covered.  Do you have any questions that you think might be helpful to ask about prep at my next appointment?  I do not want to do a bunch of research that might be wrong.  I trust this group of doctors, I think i was a work in and they just dealt with the problem at hand so I am confident they will take time with me about prep at the next appointment.  But any pointers, suggestions for questions may be helpful.

thank you

2.  Redundant and correct.  The answer is not going to change.

3.  I believe your sense is correct. PrEP is very, very highly effective for prevention of persons exposed to HIV. If you anticipate future encounters and the possibility of exposure on anything close to a regular  basis I would encourage you to strongly consider PrEP.  The challenge is determining whether you are at risk or not. Your statements on this forum suggests that your activities are very low risk. On the other hand, condoms  occasionally break and “stuff happens”.. My advice is it is that it is better to be safe than sorry. 

I hope this perspective is helpful. EWH

Dr. Hook, or whomever answers this question, thank you.  I have actually tried to purchase a new question since this is a new topic but the system will not allow it.  If I need to do that, I will be happy too.

I have thought about the advise of being on Prep, occasional male to male encounters and decided to forgo the prep and male to male encounters.  I have been seeing a female for some time and its more than physical.  So, we decided to give this a try.   We have known one another a while and our first sex was 4 days ago.  It was condom protected, and it did not break and best i can tell covered well.  Admittedly it did not last long with both very brief vignal intercourse  (3 min) and maybe 5 min of anal.  The rest was mutual masterbation.  The next morning we had the std talk (i know backwards, but i knew so much about her already).  She disclosed recent and negative testing except hsv 2, with an IGG result of 28.15 when i asked to see it.  She thinks is not big deal. She is no no therapy.

I am worried about my penis and hand, used to masterbate and see if I caught this.  Its been 4 days as of today.  I have had tingling down my legs, some in my feet.  I am not sure if that is due to a recent infection or nerves.  There is definately some ankle weakness that comes and goes but not sure if I have had this and never noticed or i am sitting wrong, which i do sit a lot in my job and have had legs go to sleep.  So my questions.  My history is that I do have HSV 1 confirmed with swab on lip, tested negative for 2 and never had symtoms in the past.

1. For condom protected sex less than 10 min, how much at risk am I?

2. Given she said she never had an anal outbreak, is that sex at risk too for HSV?

3. I assume her high value means the infection is old? New? I dont know.  Does it matter?

4. For a first outbreak do the leg and foot tingling and weakness sound like an outbreak?  Its been 2 days, no blisters.

5. I realize at 4 days, I am not out of the woods.  I assume if I can make it to 10 with no symptoms, am i good?

6. I like this person.  But I do not want herpes, if possible.  If she got on therapy and we used condoms, what is my risk? 

7. I assume me getting on therapy would not work to prevent me form getting herpes as prep would for HIV?

thank you.  I am sorry to come back so soon but this was a suprise . Also, if I need to buy another question, I will.

 It was good of your partner to tell you that she has HSV-2. Condoms provide very good protection against acquisition of HSV-2. Without condoms there is a modest risk that you will acquire HSV-2 although the risk from any single episode of unprotected intercourse is probably less than 1%.   With that, on to your most recent set of questions:

1.  As I said above, your risk of infection from the encounter you describe is very, very low. I would not be worried.

2.  Yes, the risk of herpes relates to the nerves which supply the infected area. In your partner’s case the nerves to her vagina also involve her rectum and, as a result, there is a slight risk of acquiring herpes through unprotected rectal intercourse.

3.  The value of your partners herpes blood test is strong evidence that she does have HSV-2 infection but it is not an indicator of the duration of infection or the likelihood of transmission.

4.  The symptoms you described in your legs and feet are not suggestive of recently acquired herpes in the absence of lesions. I should mention that when people begin to look for possible symptoms, it is not unusual for them to notice normal sensations which they would have otherwise overlooked as tingling or itching.

5.  Yes, virtually all persons who require herpes and develop lesions will do so within 10 days of exposure. Four days is on the early side for the appearance of lesions.

6.  If she were to take preventative therapy with acyclovir or valaciclovir it would reduce the risk of her transmitting to herpes to you with unprotected sex by more than 50%. Correct and consistent use of condoms likewise will dramatically reduce your risk of acquiring infection.  The effect of both her being on therapy and using condoms are additive and would reduce your risk for aquariums herpes very very much.