[Question #9396] Sore throat

33 months ago

I have experienced a sore throat and headache and general malaise for the last 5 weeks. My exposure was unprotected insertive oral sex and protected vaginal sex and french kissing with 2 CSW's in Mexico. Took a lab 4th gen test 2 weeks and at 27 days after symptoms developed, with non-reactive results. ENT specialist prescribed antibiotic (Mucocef), on week 3 but no alleviation of symptoms. My direct questions-

1. Do the tests rule out early HIV possibility?

2. Would early HIV symptoms persist greater than 5 weeks?

I already have HSV 1 since childhood and have not experienced fever or rash.

Waiting on throat culture results by Wednesday to determine if there is a bacterial issue. Pain is mostly in esophagus with no mouth ulcers.

Can you please comment and provide suggestions on further testing required.

Thanks

Edward W. Hook M.D.

33 months ago

Welcome to our forum. Thanks for your questions. The encounter you described was virtually no risk for acquisition of HIV. HIV is not acquired is the result of French kissing, condom protected vaginal sex, or receipt of unprotected oral sex. Further, if your symptoms have been due to HIV, your tests would’ve been positive. Symptoms occur because of the presence of high levels of virus and antibodies fighting the virus and as a result no matter when they occur, if symptoms are due to HIV, the test will always be positive. You are negative tests prove that your symptoms were not due to HIV. With regard to your specific questions:

1. Yes, your test results without rule out any possibility that you had HIV causing your symptoms.

2. The symptoms of the ARS include high fever, severe sore throat and muscle and joint aches. They typically occur between two and three weeks following an exposure and do not occur more than a month for my exposure. Further it would be most unusual for the symptoms of recently acquired HIV to last five weeks.

I hope these responses are helpful to you. While I cannot guide you as to what might be causing your sore throat, I can assure you it is not HIV. EWH

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33 months ago

Thank you for the reassurance regarding possible HIV infection. Based on the open mouthed kissing would you recommend testing for gono?I had discounted herpes as I have had HSV 1 most of my life. Would a standard throat lab culture be indicative of a gono infection?

Would you recommend a 6 week test to conclusively rule out HIV. Finally I had a VDRL test at 4 weeks. Would you suspect an issue in my case if I were your patient?

Cheers.

Edward W. Hook M.D.

33 months ago

I’m sorry my efforts to reassure you were not successful. I’ll try again with answers to your follow-up questions.

Gonorrhea is rarely transmitted through open mouth kissing and when Gonorrhea occurs in the throat it is typically asymptomatic. If you wish to entirely rule the small possibility of gonorrhea in your throat, you will need a specific test using a swab specimen taken from the back of your throat.

Herpes can rarely cause esophagitis which is manifests as pain on swallowing. Most typically there are lesions present in the back of the throat. Equally importantly, it is most unusual for a second herpes infection to occur when a person already has had the infection. I would not be the least bit worried that you have a new herpes infection of the throat.

As I already mentioned, there has never been a case of HIV acquired through the sort of exposure you described. You were not going to be the first and I see no scientific reason for additional testing for HIV. Your syphilis test taken at 30 days also rules out any possibility that you acquired syphilis in the encounter you described.

I hope this further answer so helpful to you. If any part of my responses unclear or there are additional questions, please feel free to use your final follow up for clarification. EWH

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33 months ago

The prolonged severe sore throat symptoms have certainly fueled my anxiety. Everything from a possible lab error to delayed seroconversion has crossed my mind.

Thanks for sharing your expertise and for the reassurance.

I will continue to work with my ENT Doctor for resolution.

Cheers.

Edward W. Hook M.D.

33 months ago

Delayed seroreaction is an internet fueled myth. Please don’t worry. EWH ---