I recently had protected receptive anal sex and gave unprotected oral sex to a transgender escort,they asked for my hiv/std status but I did not ask for theirs. I did not see the condom breaking. I know it was a similar exposure to my last question. 2 days later I was diagnosed with strep throat (without fever) went on clarithromycin for 10 days. After a few days on antibiotics I felt better, but a couple days later the strep throat(without fever) returned, which was 11-12 days after the exposure. I also got tested for oral gonorrhea and oral chlamydia which were both negative.I'm now on antibiotics (cephalaxin)again. My questions are,

1. Does this sound like it could be Ars? Meaning recurrent bacterial strep throat without fever?

2. Do you recommend testing?

3. A couple hour after I had a bowl movement and I wiped a bit of blood? Does that make a difference?

Thanks for all that you do!

This was a low risk exposure event. Probably you would feel it if a condom broke. Having had blood after receptive anal sex suggests the episode was slightly traumatic, which might raise the risk of HIV if exposed. But first you had to have been exposed, which is unlikely given condom use. 

Two days is much too soon to be caused by ARS. ARS symptoms do not begin sooner than 8-10 days aftere exposure. Could your second wave of symptoms be ARS? I suppose it is possible, but very unlikely. Colds and strep are hundreds of times more common than ARS, even in potentially exposed persons at risk.

Should you be tested? From a medical or risk perspective, I don't think it's necessary:  we almost never recommend HIV testing after any single exposure unless obviously high risk, such as a known infected partner. However, you certainly are free to be tested if the anticipated negative result will increase your confidence about it.Much smarter strategies are a) to be tested regularly from time to time, like every 3-6 months (for men having fairly common sex with other men, as you appear to be doing); b) start pre-exposure prophylaxiis (PrEP) with anti HIV drugs; and 3) start automatically discussing HIV status with partners before having sex -- and do not proceed (or be especially careful about condom use) with those who are infected and not on effective treatment, who don't know, or who seem evasive in their answers.

Finally, I would suggest not relying on this forum (or any other resource) for specific advice after individual exposures. Based on your two questions so far, plus perhaps scanning other threads with similar discussions, I'm sure you will know the answers!

I hope these comments are helpful. Best wishes and happy holidays--   HHH, MD

1. Is recurrent strep throat a sign of a recently acquired hiv infection or hiv infection at all?

2. My only symptom of strep was a sore throat, no swollen lymph nodes fever rash etc. Does ars involve more than one symptom?

2. Strep throat certainly can have sore throat as the only symptoms. ARS less likely, but it is possible.

Symptoms are almost never valid indicators of a new HIV infection. The symptoms of ARS include a very high proportion of all symptoms that occur with every non-traumatic medical condition you can think of, maybe even a majority of them. And all those other conditions are, collectively, hundreds or thousands of time more common than HIV -- and that includes people with recent possible HIV exposures. In other words, EVERY symptom that might indicate ARS occurs more commonly in other medical conditions. Once in a while, the pattern of symptoms after a particularly high risk exposure may be significant -- such as the combination of sore throat, lymph node enlargement, fever, and certain kinds of skin rash. But that's all. ANY other symptoms and ANY OTHER COMBINATION OF SYMPTOMS almost never are due to HIV. 

For those reasons, no matter how high you may think your risk for HIV may be, symptoms are the least helpful indicator of whether or not you may be infected. Typical symptoms usually are not ARS; and absence of symptoms doesn't rule out HIV. Ignore symptoms, rely on safe sex, and if at risk despite attempts at safe sex, get tested. No other strategies are useful to predict or prevent HIV. Got it?

Happy new year and stay safe.