[Question #8883] unprotectet insertive anal / ARS /scared

38 months ago

Hello Drs,

I live in Germany and I had the following high risk encounter. I met a girl from a sugar daddy website

: We had several encounters of unprotected oral sex, protected vaginal sex and one encounter of protected anal sex. However during anal sex, I forgot to apply lube and the condom broke. The girl has not done any HIV tests for ages. She asserts that she is clean; she told me she would do the test in the week after our meeting, but she always comes up with another excuse not having been able to do it, which makes me wonder.

Therefore, I had unprotected anal sex for at least 5 minutes. On day 7 after the exposure, my muscles started to ache mildly and on day 9 I observed a white patch on my tonsils and one tonsil seems to be swollen, however I do not have throat pain. I have no fever either. The symptoms faded away after 4 days. However, this freaks me out, as I fear that this could have been ARS. Maybe a “light” version of ARS.

1. How often does ARS start at day 7? Is it rather rare at that point in time?

2. If this would have been ARS, would a 4th gen test at this point in time (day 14) be positive?

3. How do you see the risk of me having caught the virus?

Edward W. Hook M.D.

38 months ago

Welcome to our forum and thanks for your questions. Congratulations on your commitment to reduce your risk for HIV and other STIs with condom protected sex. I’m sorry to hear that the condom broke. This occurs about 1% of the time and is slightly more likely during anal intercourse. If your partner has untreated HIV, your risk of acquisition of infection is about the same as it is for unprotected vaginal sex, about one infection in 1000 episodes of insertive anal sex. In reply to your specific questions:

Day seven following exposure is within the range when the ARS may occur although slightly on the early side. Whether or not your symptoms are the ARS or not, of course cannot be determined without testing. If your symptoms are due to the ARS, a combination HIV antigen/antibody test taken a day or two after the onset of symptoms would typically be positive. You can rule out the ARS by testing at this time.

I hope this information is helpful. If there are further questions or any part of my response is unclear, please don’t hesitate to use your update to follow ups for clarification. EWH

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38 months ago

Thanks for your reply Dr Hook!

Two further queries:

1. My symptoms resolved entirely after 4 days. Is it likely that ARS symptoms resolve in that (short) time frame?

2. Having had no fever, no severe throat ache an no severe muscle pain, are these "mild" symptoms suggestive of ARS or is ARS rather characterized by more severe symptoms?

Edward W. Hook M.D.

38 months ago

1. The duration of the ARS can be quite variable. Four days is within the reported range.

2. High temperatures and a severe sore throat are part of the classical description of the ARS. On the other hand, since over half of persons who acquire HIV do not describe the ARS, I suppose mild symptoms could occur.

Sorry for the imprecision in this response. There just are not good data on “mild” Ars. That said, odds are in your favor that your recent symptoms are not the ARS. In studies of at risk persons seeking care for flu-like symptoms, HIV was the cause in less than 1%. EWH

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38 months ago

I haf a 4 gen test 23 days after the incident which came back negative. 30 days after the incident I have a slight pain while swallowing. As there is no sore throat involved, I suspect that my neck lymph nodes are swollen causing the pain.

1. Could this second set of symptoms at day 30 past exposure be ARS related?

2. What is the earliest time to have ARS symptoms?

3. What is usually the longest time to develop ARS symptoms?

4. How reliable is a 4gen test at 23 days past exposure (in percent)?

Edward W. Hook M.D.

38 months ago

Your -4th generation test 23 days after the encounter proves that the symptoms that you experienced earlier were not due to HIV. If they had been, your test would’ve been positive with respect to your follow-up questions:

1. The period when symptoms of the ARS occur differ in different scientific publications however, most experts agree that virtually everyone who experiences the ARS will do so within 3 to 4 weeks of an encounter. For symptoms occurring 30 days after an exposure and following a negative for generation test at 23 days would be extra ordinary and most unlikely.

2. The ARS does not occur until the levels of circulating virus in the body have become very high and the body has begun to produce antibodies. The onset of the ARS symptoms would not occur sooner than day 5 to 7 following an exposure.

3. See my response number one above.

4. There are no day by day data on the reliability of fourth generation HIV tests, however at 28 days, we’ll over 98% of fourth-generation tests will be positive and 23 days I would expect somewhere in the 70 to 80% of tests to be conclusive.

As you know, we provide up to three responses to each clients questions. This is my third response. Plus, this completes this thread and the thread will be closed shortly without further responses. Take care. Please don’t worry. EWH

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