[Question #851] HIV Risk

53 months ago
Dear Drs.,

After a terribly stupid, drunken night of unprotected vaginal sex, I'm hoping you can help to assess my HIV risk.

In short, 2 days after exposure I got a cold, which, based upon my research, is way too soon for ARS.  However, along with my cold, I got a rash on my upper chest, which hasn't gone away (it's exactly 8 weeks since exposure).  Rash is reddish/brown (I'm white) is not raised, seems to be blotchy in some areas but is connected rather than a series of unconnected bumps.  It's a bit sensitive and seems to be lighter in the morning and darker in the afternoon after work.  No rash anywhere else.  

3 weeks ago (nearly 5 weeks since exposure) I developed what seems like oral thrush.  Burning red taste buds that have seemed to work their way to the back of my mouth.  At one point, as the pain moved back (several days after first seeing the bumps) I got a sore throat, lost my voice/cracking voice, and developed cotton mouth when I spoke.  Sore throat lasted a few days and is fine, but taste buds still hurt, although not at the level as before.  Also, no ulcers, cottage cheese, although my tongue felt swollen at one point, seemed almost bruised, now appears to have a slightly white film, although it's painless. I didn't feel like I had a cold/flu and don't recall bad headaches (maybe a slight headache one day but that's probably worrying) or fever or fatigue - it was really the tongue.  Between my cold and 'thrush' I felt totally fine, played sports, etc.  I've experienced no night sweats, join pain, or other symptoms that I can recall.  

Can you help me assess my risk based upon symptoms and other factors?  Her - white female from suburban area of large NE city (1/1000 of being positive?).  Insertive vaginal (1/2000?) - 1/2000000 odds?  I'm circumcised. I now realize I can get a conclusive test this week, which I will do, however I'd be grateful for any information you can provide based upon my risk factors. Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

Welcome to the Forum.  I'll be pleased to comment.  Little about the symptoms you describe concern me for the ARS or recently acquired HIV.  As you point out, your initial symptoms started too early to be typical of the ARS and the rash of ARS does not persist in the manner you describe.  Similarly, your oral symptoms are most suggestive of the sorts of viral infections that most people get from time to time, no HIV- the "slightly white film" you describe is more typical of mouth breathing and congestion than HIV.

As for your statistical risk, I would put your odds of infection at about 1 in 200,000 ( 1 in 1-2000 risk of infection if exposed, risk that your partner had HIV substantially less than 1%).

finally, since it is clear that you plan to test, my suggestion would be to do so now.  A 4th generation, combination HIV antigen/antibody test will provide you with a definitive result now (and at any time more than 4 weeks after exposure).  I am confident that your test will be negative and, when it is, I urge to you more on without further concern.  EWH

p.s.  I trust that you have already been tested for more common STIs such as chlamydia.  If you, when you are tested, please be sure to do so- your risk of this infection is far higher than your risk for HIV.  EWH

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53 months ago
Thanks for the response, Dr. Hook. Can you please let me know how confident you'd be with a negative Oraquick at home test taken at 9 weeks post exposure.  To complicate things a bit, I had a few pretzels within the 30 minute window of taking the test. Would this adversely impact the negative result?  To clarify, the test did register with a single line over the negative strip. Thanks. 
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago
I am confident in the results of a nine week Oraquick test and would believe the result.  that you ate pretzels before testing has no effect on the accuracy of the test.  Believe your test results.  EWH
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52 months ago
Dr. Hook,

Thanks again for your reply.  Out of an abundance of caution, I purchased another Oraquick test, which I recently took at 11 weeks post exposure.  This test was also negative, therefore, I'm assuming the likelihood of being positive is essentially non-existent, given my exposure and negative Oraquick tests at 9 and 11 weeks.  

I appreciate your help and taking time to answer my questions.  When my initial concern began and I started doing a bit of research, I was amazed at the abundance of bad information available online.  This forum is definitely a helpful resource.  

Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

Thanks for your thanks and I'm pleased that you found our comments helpful.  Your 11 week Oraquick result provides definitive evidence that you were not infected with HIV during the encounter that you describe.  Time for you to move forward without concern.  Take care. 

As per forum guidelines, this thread will be closed later this morning.  EWH

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