First Time - Have ARS Symptoms in Window

Doctor,

On March 10th, I engaged in M2M intercourse with an older gentlemen (~45/50). I am 23.

We both gave each other unprotected oral sex but neither of us came. Then we had protected anal sex where I was the insertive partner. I pulled out, and took off the condom, and came.

3.5 weeks later, I stared having headaches, stuffy/runny nose, and a sore throat, but no fever. I also had random allergy (I assume) rashes on my arms, but they would go away after Caladryl.

At 4 weeks, I was feeling generally tired, shoulder-joints ached, and still had several of those symptoms. I had an OraQuick HIV rapid test (finger-prick) at the local clinic at 30 days post-exposure, but it was negative.

This morning, 33 days post-exposure, I developed a rash on the left side of my face that doesn't itch, but reminds me of a sunburn in the way it appears. I also still have a sore throat, my right twitches frequently, headaches are still occurring, and I feel a slight numbness and/or pressure on the left side of my face.

I called the gentlemen that I had the exposure with and he said that I had nothing to worry about as he tested negative in December; but he also claimed to have had intercourse with three other men before me (in between the test and our encounter).

This was my first M2M encounter and now I am scared to death that I am going through ARS symptoms. My doctor said that I was fine and that I am just under a lot of stress (which is very true), but I cant help but wonder if he is wrong.

I have a few questions for you, Sir:

1) What, in your opinion, would be my actual risk?
2) If the symptoms were in fact ARS, would it have shown up on my finger-prick test at the 4-week mark?
3) Knowing that symptoms are not able to diagnose an infection, do you think that I may be experiencing them?

Could you give me some words of medical wisdom that could calm my nerves?

Respectfully,

VeryConcerned

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to comment.  This was a low risk exposure.  Condom protected sex is safe sex and there is virtually no risk of HIV associated with giving or receiving oral sex.  I understand that the symptoms that you describe do overlap with  the symptoms of early HIV however it is important to point out that when this has been studied carefully, less than 1% of persons at risk who have such symptoms turn out to have HIV.  Given the nature of your exposures and what you have learned about your partner, I suspect your symptoms are a coincidence rather than a manifestation of recently acquired HIV infection.

In answer to your specific questions:

1) What, in your opinion, would be my actual risk?
Your risk if virtually zero.  I would not worry about it.

2) If the symptoms were in fact ARS, would it have shown up on my finger-prick test at the 4-week mark?
Typically, when persons have ARS, their HIV antibody tests, including the finger stick test, are positive within a few days of the beginning of the symptoms.  Thus your negative test is further strong evidence that you did not get HIV from the encounter you describe.

3) Knowing that symptoms are not able to diagnose an infection, do you think that I may be experiencing them?
I do not think this is the ARS.

I hope these comments are helpful.  Please try not to worry.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  I suspect this is a contributor to your situation.  EWH

[rocketman97]

Sir,

I forgot to mention that I have also experienced loose stool (not quite diarrhea), and had a night sweat last night (day 33 post-exposure) and my right eye still twitches.

Thank you!

[rocketman97]

Sir,

Thank you so much for your reply; it helps out a great deal! Some things still concern me, however, that I would appreciate your insight on: I am taking Prednisone, Ciprofloxacin, and Lorazepam. Would any of those medications affect the window period?

I know that Prednisone can lower one's immune system and that the antibody response time to an HIV infection is in someways dependent upon the infected person's immune system. Would Prednisone affect your interpretation of my 4-week negative result or would you still be as confident regardless of my risk?

Lastly, do you think that a test at 6 weeks would be conclusive, given my concern for my symptoms (e.g. if it was ARS, it would show up by then)? I would still test at the 3 month mark, per CDC standards, but it would put me at ease to know that I need not worry for 7.5 more weeks.

Thank you for your response and I look forward to reading your next one!

[Edward W Hook, MD]

Your questions about testing are a bit off target since I don't think testing was warranted to start  with.  I'll briefly answer your questions about testing but will not get into an extended exchange over something that I see no reason to do in the first place.  If you want more information on test performance you can search tis site as we discuss test perfromance with others on an almost daily basis.  

Prednisone can delay and modify antibody repsonses.  Ciprofloxacin and lorezepam woul dhave no effect.  If you are tested with a combined HIV p24 antigen/HIV antibody test however, your results should be reliable at just about any time more than 4 weeks after your exposure.  

Regarding your 6 week test and symptoms, I'll repeat what I said above- "when persons have ARS, their HIV antibody tests, including the finger stick test, are positive within a few days of the beginning of the symptoms.".  In the absence of symptoms, despite the CDC's out of date, overly conservative recommendations (desicussed elsewhere on this site repeatedly), a negative test at 8 weeks is definitive.  In theory taking prednisone MIGHT delay this but there are no data to say how often or to what degree.  EWH

[rocketman97]

Thank you!

I understand that my fears are unwarranted, but as you can imagine, being a "worried-well" with appropriate symptoms in the correct time frame is a little nerve-wracking; especially as this type of exposure was my first! I have definitely learned that my exposure was a minimal risk and that my symptoms are more likely anxiety mixed with a common illness than the manifestation of HIV.

However, in order to quiet that "voice in the back of my head", I feel that setting an attainable testing time for which to conclude my fear and provide closure would help me a great deal.

Knowing that you are not "All-Knowing", I have one more question for you. As I have been taking Prednisone in 5 MG tablets on a 3/day the first the 3 days, 2/day the next three days, and 1/day for the last three days schedule that started on March 29. As my exposure (I know that you, and many others, do not consider it a risk at all) was on March 10th, would you say that tests (albeit unwarranted) on April 20th (6-weeks) and May 4th (8-weeks) would be scientifically appropriate to eliminate all concerns that I may have?

I do not intend for you to repeat yourself as I value your time, but rather to pacify the remaining "worried-well" in me so that I can get some sleep!

Thank you for your support!