[Question #9645] ARS symptoms and timeline
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30 months ago
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Hi! Thank you for such a great service. In May of last year I had vaginal and anal sex with a bf on 5-21-22. Approx 9-10 days later he was sick. His ex wife tested positive for COVID which in turn infected his daughter and his mother who was severally sick they all lived together at the time. He was unvaccinated (not good!). His initial test was negative 6-1-22 after his ex wife informed him. On 6-3-22 I swabbed him twice on rapids and COVID showed up immediately. I had had it about 3.5 months before and I am vaccinated boosted the works. I don't think he had a fever but headache, fatigue, congestion, runny nose, scratchy throat, loss of taste and on 6-14 we noticed red Petechaie on his lower calves and feet and purpura on his knee. No rash elsewhere and this rash lasted until 7-8 I believe. At the time of the rash he didn't have COVID symptoms. The above symptoms went away within 8-10 days or so. He then tested negative on a rapid. Then it went away. I reached out to my prior partner before this bf who is divorced with 3 kids states he's never had an std he is not bisexual or a drug user but he has a gay friend which I questioned for no reason at all he's since moved on to another relationship with a new female. AtI obviously got concerned about the rash and googled it- which is a manifestation of COVID as well several rashes are. My questions are below.
1- Does this sound like ARS? Should I be worried?
2- I have seen conflicting info does ARS last 1-2 weeks or longer?
3- My ex bf before this one and I had unprotected vaginal sex once or twice NO ejaculation into my vagina. Does precum transmit hiv? Or does NO ejaculation help? I never had symptoms after the 1-2 times no condom- again NO ejaculation into me. I assume a lot more is needed then precum such as full ejaculation.
4- I have read the rash for hiv is generally on the torso upper body trunk, torso, neck red viral rash. Does his manifestation of lower calve issues sound like ARS?
5- Would a rash really last thay
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30 months ago
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My phone glitched! Would a rash of ARS last that long without anything else?
Thank you both for your work from one healthcare worker to another!!
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Edward W. Hook M.D.
30 months ago
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Welcome to the Forum. Thanks for your questions. I'll be glad to comment:
Before I get to your specific questions, let me provide a bit of information about the ARS. The ARS is the syndrome which occurs in some but not all persons who have recently acquired HIV. The illness is a severe flu-like illness in which affected persons have HIGH fever, SEVERE sore throat, and muscle and joint aches. Some people with the ARS get a rash which, as you mention, is typically on the truck, torso, neck, etc. The ARS typically occurs between a week and three weeks following infection and virtually never occurs more than a month after infection. Once a person has had the ARS their HIV test will be positive forever thereafter.
Most flu-like illnesses are NOT the ARS. Careful scientific studies have shown that when at risk persons have a flu-like illness, more than 99% have something other than HIV including COVID-19 and influenza as well as a lot of other, non-specific community acquired, non-STI viral infections
It sounds to me like your BF had classical COVID last may- he was exposed within his household, his symptoms are quite characteristic and while the rapid tests sometimes miss the infection, they are accurate when positive. With that, let's address your questions:
---1- Does this sound like ARS? Should I be worried?
As I noted above, his illness sounds a bit like the ARS but it sounds more like COVID. Further, as a heterosexual man, he is statistically unlikely to have acquired HIV.
2- I have seen conflicting info does ARS last 1-2 weeks or longer?
Most typically the ARS resolves on its own over a week or two after the onset of symptoms.
3- My ex bf before this one and I had unprotected vaginal sex once or twice NO ejaculation into my vagina. Does precum transmit hiv? Or does NO ejaculation help? I never had symptoms after the 1-2 times no condom-
again NO ejaculation into me. I assume a lot more is needed then precum such as full ejaculation.
Actually, pre-ejaculate can transmit HIV, as well as other STIs and make you pregnant. Ejaculation does not need to occur.
4- I have read the rash for hiv is generally on the torso upper body trunk, torso, neck red viral rash. Does his manifestation of lower calve issues sound like ARS?
This would be most unusual for an HIV rash.
5- Would a rash really last that long without anything else
No
Bottom line, it sounds like your BF had COVID, not the ARS. I would not be worried about HIV. While it's none of my business however, since both this BF and your prior partner have had other partners, just to be on the safe side, get testing for the other STIs, which are far, far more common, like chlamydia, trichomonas, and gonorrhea might be a good idea unless you have already be tested. I'm not implying anything, just better safe than sorry
I hope this information is helpful. EWH
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30 months ago
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Thank you for the response!
All more common STDs were negative. A couple final questions and to clarify.
1- Can COVID mimic the ARS? I assume all respiratory virus's could.
2- Regarding the rash- a rash on the legs and specifically Purpura and Petechaie is not the commonly looked for rash correct? Should I forget about it?
3- From what I've read it's a viral rash. How long would it typically last?
4- Would an ARS rash come on after other symptoms and last a total of 5 or 6 weeks? I am not for sure I asked clearly and therefore want to clarify!
5- Is hiv "all over" and easy to catch as indicated in the media?
Once the above is clarified should I forget about the leg rash and hiv?
Thank you and I hope you have a great day!
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30 months ago
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One last question so sorry! Are sinus symptoms part of ARS? Forgot to add that! Thank you!
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Edward W. Hook M.D.
30 months ago
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in reply:
1- Can COVID mimic the ARS? I assume all respiratory virus's could.
Yes. I thought I expressed that above.
2- Regarding the rash- a rash on the legs and specifically Purpura and Petechaie is not the commonly looked for rash correct? Should I forget about it?
Correct. I'd forget about the rash.
3- From what I've read it's a viral rash. How long would it typically last?
Highly variable.
4- Would an ARS rash come on after other symptoms and last a total of 5 or 6 weeks? I am not for sure I asked clearly and therefore want to clarify!
No, it would not. The symptoms of the ARS typically occur at about the same time and do not last 5-6 weeks.
5- Is hiv "all over" and easy to catch as indicated in the media?
No it is not. There are no exposures in which the risk for acquiring HIV from a single exposure is greater than 1% and in most situations it is substantially less
6. No, sinusitis and respiratory symptoms are not part of the ARS.
EWH
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30 months ago
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Final reply. What I gather is below.
You indicated a "bit" like ARS but more like COVID. So basically timing could be correct as to when they came on after intercourse (and COVID given the ex wife's result) but the symptoms are not meaning they are respiratory in nature cough, scratchy throat, congestion, runny nose that fullness and headache and don't include a high fever, severe sore throat or typical rash red flat viral rash on the trunk abdomen face neck/ severe aches and pains but something you'd see with the COVID virus.
1-Do I understand this correctly?
2- Timing is right symptoms are not as they are respiratory in nature?
2- In addition to forgetting the leg rash/ Petechaie and Purpura I can forget about ARS/HIV also.
I think I interpreted correctly!
I understand this is my last question writing instead of talking is always hard in terms of clarification so thanks for baring with me! Since I won't be able to respond to your reply thanks again!
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30 months ago
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After sending my final question to clarify the rash was on his claves the front of his lower leg down towards his ankles then feet with the purpura by the knees I didn't clarify that above I assume it makes no different that some was on the front lower leg and to again just forget about it.
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Edward W. Hook M.D.
30 months ago
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Straight to your follow-up questions:
1-Do I understand this correctly?
Yes, you are correct. He had a flu-like illness. The evidence is most consistent, including test results are most consistent with COVID, not the ARS. As I said in my original reply, "Most flu-like illnesses are NOT the ARS. Careful scientific studies have shown that when at risk persons have a flu-like illness, more than 99% have something other than HIV including COVID-19 and influenza as well as a lot of other, non-specific community acquired, non-STI viral infections." You have an alternative explanation for his symptoms- COVID.
2- Timing is right symptoms are not as they are respiratory in nature?
Correct
2- In addition to forgetting the leg rash/ Petechaie and Purpura I can forget about ARS/HIV also.
That would be my advice. The additional information you provide about his rash does not change my assessment.
As you know, we provide up to three responses to each client's questions. This will be my final response and the thread will be closed shortly. Take care. Please don't worry. EWH
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