[Question #9406] Testing and ARS? Oral Risk
33 months ago
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Dear Doctors,
I hope you don't find my question repetitive, and if you do, please accept my sincerest apology. I wanted to clarify some information regarding a new encounter that I was not able to find elsewhere.
The encounter involves kissing, which we agreed upon as NO risk, fingering with no cuts, also previously discussed as NO risk, and lastly very brief insertive oral sex, which is the reason behind my question. My partner was a 20yo college student female, that according to her, does not engage in condomless sex nor give oral sex, with a total of 4 sex partners ever. Unless she is lying (she was dodgy about testing when asked), she seems to be on the lower end of risk.
My PCP asserts that receiving oral sex is a "low" risk activity, but didn't provide any further detail when asked about how low is low risk.
1 - Is it fair to assume that oral sex only presents a risk to the person giving it and no risk to the person receiving it? I don't find much detail on this, as I hear statements of "little to no risk", so your expertise would be very helpful.
Additionally, despite being reassured with the level of risk, as I developed some very strong symptoms, I find myself quite alarmed about an HIV infection. Around week 3 (day 23), I started developing fatigue and a scratchy throat. I consulted a doctor who on video seemed to say that my tonsils were not swollen and that it wasn't a sore throat, but I did experience slight discomfort and pain. No fever or rash. To be safe, I went in and tested with rapid Alere AgAb at 27.5 days that was negative but this was only 1-2 days after onset of symptoms.
2- Would this be sufficient to know that my symptoms are not due to HIV? Was it too early to test after the onset of symptoms?
3- My symptoms came back around day 37 until now (39), with a strong cough, raspy voice, drowsiness, pain in upper chest and metallic taste in throat. Can this be ARS or continuation of it?
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Edward W. Hook M.D.
33 months ago
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Much of what you are asking is repetitive. I will provide brief replies to your questions:
1 - Is it fair to assume that oral sex only presents a risk to the person giving it and no risk to the person receiving it? I don't find much detail on this, as I hear statements of "little to no risk", so your expertise would be very helpful.
Additionally, despite being reassured with the level of risk, as I developed some very strong symptoms, I find myself quite alarmed about an HIV infection. Around week 3 (day 23), I started developing fatigue and a scratchy throat. I consulted a doctor who on video seemed to say that my tonsils were not swollen and that it wasn't a sore throat, but I did experience slight discomfort and pain. No fever or rash. To be safe, I went in and tested with rapid Alere AgAb at 27.5 days that was negative but this was only 1-2 days after onset of symptoms.
There are no proven cases in which HIV has been acquired from receipt of oral sex. If your symptoms were due to HIV, your test would have been positive. When symptoms are present, tests are uniformly positive, even 1-2 days following the onset of symptoms.
2- Would this be sufficient to know that my symptoms are not due to HIV? Was it too early to test after the onset of symptoms?
See above.
3- My symptoms came back around day 37 until now (39), with a strong cough, raspy voice, drowsiness, pain in upper chest and metallic taste in throat. Can this be ARS or continuation of it?
No.
I urge you to work to put aside your unwarranted concerns regarding the sorts of virtually no risk events that you describe in this and past posts. EWH
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33 months ago
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Hello Dr. Hook,
Thank you for the reply. To get more clarify in the ARS, could you elaborate on the timing and the usual symptoms of the ARS?
1- For my first bout of symptoms occurring between the 3 and 4th week, the test would prove they are not due to HIV, but were they or their timing typical for ARS? It was: Fatigue and Throat Discomfort
2- For the second bout of symptoms, the one that occurred after the test, around 5 weeks, was the onset too late? Is the fact of having strong dry cough, a lot of phelgm, and slight upper chest/throat pain not typical for HIV?
3- With my negative rapid AgAb test at about 28 days and the low risk of the exposure, what are the odds of the test turning positive at 45 day mark? Sorry doctor, but my current symptoms are really worrying me.
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Edward W. Hook M.D.
33 months ago
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Sigh. These are repetitive questions. I suppose you cannot help yourself. The ARS occurs as virus concentration in the blood interacts with antibodies formed in response to the infection. It typically occurs between one and three weeks following exposure and does not occur beyond 30 days. 4th generation HIV tests are always positive in the presence of the ARS which is characterized by high fever, severe sore throat, and widespread muscle aches. The same symptoms are caused by influenza, COVID 19, and many other far more common viral infections. When persons seek care for the flu-like symptoms I described, over 99% have something other than HIV. Thus:
1. Your mild symptoms do not suggest the ARS.
2. Too late. Cough is not part of the ARS.
3. Virtually zero
You need to move on. EWH
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32 months ago
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Hello Dr. Hook,
First of all, let me thank you again for your patience with me. I know the questions can be repetitive, but in the moment, it's hard to move on without confirmation from experts like yourself. To give you an update, I did a lab-based AgAb at 44 days and 20 hours (I know it's a bit shorter than 45) and it came back non-reactive. I know it definitely rules out the ARS possibility as you have already told me, but this should be sufficient to be conclusive, right?
The other follow-up, and mainly to avoid posting in the future, is about non-sexual exposures. I have been abstinent from any sexual contact, no matter how trivial the risk can be, for the past 8-9 weeks until I continue working on my HIV fear through professional council. I also do not do any kinds of drugs, injection or not, so I don't see any potential HIV risk (from major transmission verticals) in my day-to-day life. The only thing I suspect is haircuts. I have sensitive hair follicles, so often times at the barbershop, my skin ends up getting irritated due to contact with clippers (my barber always changes the razor). Some areas of my neck would look red, similar to a cut, but I wouldn't see any bleeding. If any cuts occur, they tend to be slight but spread over the neck area. I usually check the clippers beforehand at the barber, and there is never visible blood on them. I also inquired with my infectious disease doctor and he said there is no infectious disease risk from a haircut. However, some articles claim the risk exists and my family medicine doctor agrees. Would you be able to advise me on the risk of hiv from a barber clippers in case of cuts/contamination? This article is what created the worry for me: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932524/
I know the thread will be closed after this so I want to wish you happy holidays ahead and thank you for your help so far. I hope you don't see me here anymore (for good reasons :) )
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Edward W. Hook M.D.
32 months ago
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Brief answers to your repetitive questions:
Your 44.5 day test results are entirely conclusive. I urge you to believe them.
I presume the "articles" you mention are on the internet. If so, or even if not, they are wrong. Some might argue that there is a theoretical risk from being cut or scraped in a barber shop after clippers or razors were contaminated by an infected person but there are NO proven or even suggestive evidence that this has EVER happened. P{lease ignore the article you found and stay off the internet.
This completes this thread. Please do not return with further repetitive questions regarding no risk situation. If you do, your questions may be deleted without return of your posting feel. Instead, I urge you to continue to work with your counselor to address your unwarranted fears.
Take care, EWH
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