[Question #8720] HIV concern
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40 months ago
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Hello Doctors,
Thank you for all you do.
Here is my concern:
I am a heterosexual male from Maine, and on 2/28, had a first time (and only) sexual exposure with another male.
I was very intoxicated so my memory is quite blurry. From what I recall, we both engaged in unprotected oral and vaguely recall receiving anal. From what I do recall, it was not long lived as they had trouble maintaining erection, and no ejaculation.
Due to my concerns, I saw a local clinic and began PEP within about 60ish hours of exposure, on 3/1.
On the same day, 3 days after exposure, I noticed significant red patches on my soft palate. That subsided within a matter of 3-4 days (tested negative for gonorrhea and chlamydia both that week and at the 2 week mark). Any other cause for that irritation?
I just completed PEP on 3/28. I had some interesting side effects (numbness/tingling in extremities for example). I did miss a single dose around the 14 day mark.
On day 26 (6 days ago) I noticed swollen and slightly tender lymph nodes on right side of neck. Those have subsided slightly over the past several days. 1 day after PEP (this past Tuesday) I began experiencing a sore throat. This has persisted for a few days. I have not had any other side effects such as fever, etc. As I will have my follow up on Monday, 4/4, I wanted to ask for your thoughts on risk assessment?
I’ve taken 2 Oraquick tests, one on this past Sunday and one this morning, both negative. (It’ll be 5 weeks on Saturday). I thought where I had some symptoms, a negative even this early may be somewhat reassuring?
I go on Monday for a follow up HIV test, syphilis, and blood work following PEP. Will have additional HIV test at 3 months.
Thank you for any additional reassurance!
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Edward W. Hook M.D.
40 months ago
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Welcome to our forum. Thanks for your question and for the detailed recounting of your exposure, test results, and recent symptoms. I’ll start with a general comment then answer several of your specific questions.
Apparently you do not know whether or not your partner was HIV infected or whether or not he was on therapy. Both of these variables are important as obviously you cannot acquire HIV for a person who is not infected. It is also less well-known that persons who have HIV and are on effective therapy are not infectious for sexual partners. Thus, here in the United States only a small fraction of persons with HIV turn out to be infectious for sex partners. Even if your partner did happen to have untreated HIV, your risk for infection would be relatively low as substantially less than 1% of single anal exposures to HIV lead to infection. The infection rate following performance of oral sex on an infected partner is far lower, on average one infection for more than 10,000 exposures.
PEP Initiated with within 72 hours of exposure reduces risk for infection still further, Somewhere on the order of another 90%. Yes, overall your risk for acquisition of HIV during this encounter was very, very low.
As for your specific questions, presuming that you were tested for Gonorrhea and Chlamydia at all sites of exposure, you’ve proven that you were not infected with these organisms. There is no reason for continuing concern or further testing for the these pathogens. I do not have a good explanation for the areas of irritation on your soft palate but the fact that they were short list pretty much assure you that they were not an STI of any sort
You’re more recent symptoms are unlikely to reflect HIV or any other STI’s. While the Oraquick test is our least favorite test because of slightly lower sensitivity than other tests and because it tests only for HIV antibodies, your results are evidence that you were not infected. You could be even more confident that the symptoms you experienced were not due to recently acquired HIV if you were to test with a combination HIV antigen/antibody test. If this test is negative you can be completely sure that your symptoms are not due to HIV.
I hope this information is helpful to you moving forward. I agree with your plans to test early next week and with those results, believe that you will be able to have a high degree of confidence that your recent symptoms were not due HIV. Overall, the likelihood that you were infected due to your encounter you described is very, very low. EWH
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40 months ago
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Hello Dr. Hook,
Thank you for your quick and thorough response.
You have certainly alleviated some of my concern pertaining to my recent symptoms and Oraquick tests.
I have one follow up question.
With my HIV test this Monday, 4/4, this will be 1 week following completion of PEP. How much confidence should I have in this test? I will be scheduled to have a follow up test at 3 months, and then potentially 6 months.
Would you be able to provide me a sense of what level of confidence I can walk away with following the test at 1 week following PEP (~5 weeks post exposure), 3 months and if 6 months is necessary?
Thank you again!
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Edward W. Hook M.D.
40 months ago
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The data on the accuracy of HIV testing following completion of PEP is scant, in part because relatively few people who take it are subsequently proven to have the infection. As already described above, the risk of the exposure you described was very low to start with and I would be very surprised if you were found to have acquired HIV from the exposure you described. Few experts would take much additional comfort in a negative test just one week following completion of PEP. Most experts feel that results can be considered conclusive at six weeks and certainly by three months following completion of the medication. EWH ---
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40 months ago
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Thank you, Dr.
I really appreciate your time. I’ve been very stressed for over a month now. You have helped to somewhat calm a very anxious mind.
I realize I didn’t mention that I had a sore throat with the soft palate irritation early on. That resolved in the matter of days as well.
I did notice today redness on the underside of both forearms. Is this location typical for ARS rash?
In your experience, do ARS symptoms vary in onset and intensity? (Swollen lymph nodes earlier in the week, then sore throat, then forearm irritation). Still no fever yet.
Thank you and that will be it for my questions.
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Edward W. Hook M.D.
40 months ago
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As you know, we provide up to three responses to each clients questions. This will be my final response. Following the response thread will be closed without further replies.
The ARS is characterized by high fever, severe sore throat, and severe muscle and joint aches, all occurring at about the same time. In a moderate proportion of persons experiencing the ARS, they experience a generalized not localized rash. The transient sore throat and rash under your arm you describe Are in no way consistent with the ARS and suggest to me that you were looking all too hard for signs of infection that are not going to be there.
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