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HIV Risk/Symptom Evaluation
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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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HIV Risk/Symptom Evaluation

Dear Dr.,

I'm a doc who had the following encounter and symptoms:

I stupidly went to a strip club and received a handjob using some sort of lotion from a stripper in the back room.  Although I was drunk, I have a decent complete recollection of the event.  I didn't consider this event to be any significant risk however exactly 3 weeks later I awoke with malaise, headache and a sore throat.  I did not have a fever or any rash.  I managed this with ibuprofen and felt remarkably improved the next morning.  However, for the subsequent 10 days I had unilateral odynaphagia which felt like it was arising from my soft palate without any significant erythema or visible sores.  I had 1-2 palpable cervical LNs on the same side of the pain and had a few canker sores on my tongue which I get several times a year that resolved quickly.  This was accompanied by a cough which lingered in some capacity for 3-4 weeks.  The painful swallowing resolved concurrently with the completion of a z-pak, although this is more likely coincidence.  However, a week after the resolution of the odynaphagia it returned in a milder form on the opposite side and then resolved again in 3 days without any intervention.  The dry cough persisted throughout this whole illness and then for a week or 2 longer on its own.  Again, I never mounted any real fever or chills and any sick feeling/malaise had completely resolved 48 hours after onset although these symptoms continued as described above.  Although i know my exposure is considered low risk, I am usually healthy and this is a bizarre constellation of symptoms that unfortunately followed my event in the appropriate time course for ARS.

My questions are:
1.  Would you consider this constellation of si/sx at all plausible for ARS?  Do the absence of fever/chills and a lingering, dry cough rule that out as a possibility?
2.  Does this sound like any other particular STD or specific viral illness?
3.  Does it warrant HIV testing at all?
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Welcome to our Forum. I'll try to help.  While the symptoms you describe do resemble the descriptions of many components the ARS, they also precisely match with the symptoms of countless other community acquired viruses which circulate in our communities to cause sore throat, pain on swallowing and locally swollen lymph nodes.  Further, virtually all cases of the ARSD reported in the literature report fever and usually as rash as part of the ARS as well. When persons with flu-like illnesses seeking care in emergency rooms have been studied for the ARS, less than1% of at risk persons are found to have HIV.  My suspicion is that your illness is coincidental to the no risk exposure you report and nothing more., I would not worry and in fact, scientifically see no read to even consider ARS based on the activities you have described.

In answer to your specific questions:
1.  Would you consider this constellation of si/sx at all plausible for ARS?  Do the absence of fever/chills and a lingering, dry cough rule that out as a possibility?
See above. Both the absence of fever and the presence of a non-productive cough make ARS most unlikely.

2.  Does this sound like any other particular STD or specific viral illness?
Most of the community acquired viruses of the sort that circulate in communities go un-identified and un-named, largely because there is little reason to do so since there are not specific therapies available..

3.  Does it warrant HIV testing at all?
I see no reason for testing.
I hope my comments are helpful. EWH
I would not worry and do not even see any need for testing related to the activities you have describe above.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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