HIV - Prevention Expert Forum
Blowjob, Cunnilingus and ARS
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Blowjob, Cunnilingus and ARS

Dear Dr HHH and Dr Hook,

I try to make it short: 9 days ago I went to a CSW. She performed an unprotected blowjob on me, I performed unprotected cunnilingus (no menstruation as far as I could see or taste) on her. We also had sex (vaginal) but that was fully protected.

5 days later I started to have a sore throat, not very bad, but existent. In the evening I also started to sweat quite much. I felt like I would have a fever, but the highest temperature that I measured was 99,5°F and I guess that's no real fever. So maybe just malaise. This condition lasted for 4-5 days: sore throat, often sweating, malaise. Today I feel pretty normal again.

My questions are:

1. How would you judge the risk of my exposure? High enough that an infection has to be considered?

2. Could ARS start as early as 5 days after exposure?

3. Could it be ARS if no fever above 100°F?

4. Could ARS last only for 4-5 days?

5. Are there any other STDs likely in regard to my exposure and symptoms?


Thank you very much for taking your time! It will be a great help!!


P.S.: Please excuse my poor english. I am not from an english speaking country.
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Your exposures were not no risk but they were low risk.  The estimated risk for receipt of oral sex is about 1 in 20,000 exposures, if your partner is infected: for performing cunnilingus is slightly higher, 1 in 10,000.  Each of these statistics however is relevant ONLY if your partner had HIV and the odds that she was infected are low (less, probably far less than 1 in 10).  Thus you have little to worry about.  

As for your symptoms, the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.

Now for your questions:

1.  See above.  Low.  You decide if a less than 1 in 100,000 chance is worth worrying about.
2.  It would be uncommon
3 & 4.  You have been studying the ARS.  I hope no one that you read "defined" it too strictly because it is not well defined.   Trying to sort things out based on the duration or symptoms, height of fever etc is something that no responsible physician would do - neither should you.  Your symptoms complex does not match well with the ARS.
5.  Any time one worries about HIV, they should also worry about hepatitis B as well.  That disease is also very rare and almost never spread (if ever) through oral sex.

My advice>  Don't worry.  At some time in the future you may want to get an HIV test but if you acquired HIV through oral sex, you would be the first I've seen in taking care of persons with and at risk for HIV since the epidemic began. In the future, reduce your concerns by using condoms. EWH
7 Comments
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Avatar_m_tn
You used a condom for vaginal sex and only recieved oral ( No documented cases ever).  = No risk, after reading what the doctors have said in the past about this exposure I am pretty sure this is what they will say.
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Avatar_n_tn
Dear Dr. EWH,

In a May-2006 post, Dr. HHH stated that typically an ARS fever is anywhere up from 100 F. I recognize that it could vary, but it seems that all clinical studies suggest that if a person has ARS he presents at a medical practitioner (this would suggest that the temperature is greater than 99, I would think) and I'm assuming by that post that he meant that if one gets a 99.0 for 1 hour (and then goes back to 98.6 to 98.8 for the rest of 4-5 days) it means nothing. Just looking to clarify based on the thousands of patients that Dr. HHH and you have seen over the past years.

Thanks much for your time and appreciate what experts such as you and Dr. HHH provide to this forum.  

JS
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300980_tn?1194933000
There is a lot of bias involved in trying to define what is and what is not ARS.  The persons who have been reported tend to feel pretty sick but of course that is why they come to the attention of health care providers.  To try to rule in or out the syndrome based on such details is going to get people in trouble.  Having said that, nevereveragain needs to know that what he is experiencing is almost certainly not ARS and does not really ressemble it at all.  EWH
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Avatar_n_tn
Dear Dr Hook,

thank you very much for your help.

As my throat remained sore I decided to see a doctor last Saturday. They took a throat swab. Turned out I have oral gonnorhea (Gonorrhea).

As far as I understood this might explain the sore throat, but what about feeling feverish? Could this be also a symptom of gonnorhea (Gonorrhea)? Or does the diagnosis of gonnorhea (Gonorrhea) and my slightly elevated temperature make an additional infection likely?

I would highly appreciate if you could give an answer to this question. I promise it will have been my last one.

Thank you very much!!
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300980_tn?1194933000
Getting gonorrhea from cunnilingus is very unusual but you should believe the cultures.  The presence of gonorrhea could explain your sore throat although most gonococcal throat infections are asymptomatic.  Alternatively, you could have a usual, viral (non-STD/HIV) sore throat.  Common things are common.  I'll take you at your word, no further questions please.  EWH
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Avatar_n_tn
And I keep my promise. Thank you very much, Dr Hook. You and your colleagues are doing a really great job here.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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