[Question #956] HIV after single protected exposure

50 months ago
Hello Doctor, 

I posted a question about a week ago where I had protected vaginal sex with a csw in one of those Asian massage parlors. I had a lot to drink that night but I know the massage woman put a condom on me herself and we engaged in brief vaginal sex until i realized what I was doing and left. At 3 weeks I wasn't showing too many symtoms besides some PN (which may or may not be a sign of ARS) and some diarrhea. It is now been 4 weeks since the single exposure and I have some other symptoms going on. I have had off and on burning/tingling all over my body. Muscle aches in my thighs and calf muscles. Some mild pain in my lower back. I also had a headache that would go off an on (usually one side of head). Diarrhea that persisted but I was also on amoxicillin for something else. Still no fever, sore throat, rash (maybe a mouth ulcer or two, but they've healed), or any of the obvious signs. But the headache, muscle aches, and diarrhea are definitely there.

My questions: Are these ARS symptoms? I live in Dallas, does this add to my risk? I'm almost positive the condom remained on and in tact the whole time but not 100%, could this just be my anxiety flaring up? Also I've read that PN can be a sign of ARS in rare cases. Have you ever heard of something like this?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome back. But sorry to see you remain far more concerned than warranted by either the exposure or your symptoms.

As indicated in my previous reply, the answer to one of your specific questions is no:  I've not heard of peripheral neuropathy as a symptom of ARS. If indeed you found accurate informaiton that it can happen (I cannot comment on sources I haven't seen), it must be very rare. 

Your other symptoms are not suggestive of ARS either. ARS certainly doesn't cause body wide tingling or back pain, and although it could cause headache or diarrhea, even these would only be in conjunction with the other typical symptoms you mention.  You're making the same mistake I alluded to last time:  you cannot simply read lists of symptoms of ARS, see one or more that you have, and conclude you might be infected. Every symptom of ARS occurs in a hundred other medical conditions, almost all of which are more common than ARS, even in exposed persons at high risk (which you are not). Please lay off the internet about this! It's a waste of time and emotional energy, just making you more anxious.

As for whether anxiety is the cause of your symptoms, I would say a) these certainly are typical symptoms for the physical manifestations of anxiety or other psychological problems, and b) whenever someone suggests anxiety may explain his or her own symptoms, usually s/he is correct. So it seems a good bet, but only in-person professional evaluation can make a specific diagnosis.

And why haven't you been tested for HIV as we discussed last week? It's now about 4 weeks after the event, and an antigen-antibody (4th generation) test would be conclusive. It's pointless to be asking questions like this when a definitive answer is easily available. I'll be happy to comment further if you'd like to post your test result when done. But not until then.  OK?

In the meantime, do your best to mellow out. This really was a zero risk exposure for all practical purposes. In my 12 years of doing online forums, with thousands of questions like yours, not one person has turned out to have caught HIV. You're not going to be the first. Don't let your mind get mixed up between anxiety over a sexual decision you regret and the medical consequences of that decision. They aren't the same. Deal with the former as you need to, but you really needn't worry about the latter.

Regards--  HHH, MD
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50 months ago
Thanks doctor, 

The reason I haven't done the 4th gen HIV test yet is because I am still waiting on the RNA test to come back. Since Dallas has a relatively large gay population, there is a state run facility that gives free HIV RNA testing in 7 business days. I get those results Monday. I will also do the 4th gen test on Monday as well and let you know of my response. Thanks again.
50 months ago
Dr. HHH, 

I just received my results from my test. 

HIV Ag/Ab EIA = Nonreactive 
Syphilis IgG = Nonreactive

The nurses at the clinic told me that these tests were conclusive and there's no need for retesting. The blood was drawn 20 days post possible exposure. Do you think I need to be retested? I thought they were doing an RNA test but I guess not. 

On another note, I have developed what I believe to be a common cold, seriously congested, headache, post nasal drip, and fullness in the ears. Still no fever, sore throat or rash. From your other posts I take it these symptoms have zero do to with HIV but I just thought I'd throw those out there. 

Please let me know if I need to be retested or not. If not I will sleep like a baby tonight. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
'The nurses at the clinic told me that these tests were conclusive and there's no need for retesting." They are correct, as I said above. Test resutls always overrule symptoms. You caught a cold, that's all. No further testing is needed. Rock-a-bye baby: sleep well!


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50 months ago
I just wanted to make sure the 20 days post possible exposure was enough time for an accurate result. Thanks for all of your help and reassurance, doctor! It's great to know there's a place online we can come to for reliable information. I'll be sure to not make this mistake again. Not worth it in any way. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Official advice about time to conclusive tesing varies from 4 weeks to 3 months, depending on the test, so 20 days is on the early side. However, the combination of RNA plus antibody testing is definitive by 20 days. As an example, RNA or DNA testing, plus antibody, is used to test all blood collected before transfusion, and has been 100% successful in preventing transfusion related HIV infecitons. There have been no such infections known in the US, among millions of transfusions, since 2008 or thereabouts.

I always advise people to be very careful about making promises to themselves about sexual decisions. For most people, it's about as successful as dieting for weight loss. Don't understimate the power of temptation to overcome rational intent!

That completes the two follow-up comments and replies that come with each question, so this thread will be closed. You can go forward with complete confidence you don't have HIV. Best wishes and stay safe.

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