Risk and Symptoms

[perhaps_unneccessary]

Hello, doctors.

I'm a young, sexually active gay male. From time to time I meet a man from the Internet and engage in safer sex practices like fellatio (mostly with me performing it) and mutual masturbation. I never engage in anal sex with these men, and I always, always ask about HIV status. My last test was two months ago and the result was negative. So, normally, I'm not very worried about HIV. However, I have a concern that I hope you can address.

About three weeks ago or so, I met such a man and I performed fellatio on him for a while. Toward the end of our encounter, I was lying on my back with my legs spread and he was masturbating over me. When he ejaculated, quite without warning, he aimed his penis downward and a small amount of ejaculate landed in my anal region. I moved as quickly as possible to gently wipe it away, and I doubt that much (if any) could have entered my body. Since he said he was negative for HIV, I thought nothing more of it.

This last Sunday, however, I got really sick. It occurred within the time range appropriate for ARS, so that's a little worrying. Now, the first symptom was a very sudden onset of nausea followed by a night of vomiting, abdominal cramps, and abnormal bowel movements. The next day, I had very uncomfortable muscle aches, body chills, and a temperature of 101F. Today, my temperature has hovered around 100F and I've felt tired and achy but not sick to my stomach.

I dug up some information, and it seems to me that vomiting isn't really a common ARS symptom (though fever and muscle aches are). The vomiting and abnormal bowel movements seem more in line with gastroenteritis to me, but I'm not sure about the fever, muscle aches, and chills. I did eat a caesar salad about twenty-four hours before the onset of the illness, so I guess it could conceivably be salmonella poisoning. Do you agree that gastroenteritis is more likely than ARS?

Thanks for your input.

[Edward W Hook, MD]

Wrong...oral is no risk.  I'm confident your test will be negative.  EWH

[perhaps_unneccessary]

Well, the symptoms started three weeks after the event, and there WAS penetration, but it was only oral... which is low risk. Intellectually, I'm convinced that I had a gastrointestinal virus, but the test next week should quiet the less logical part of my brain.

[Edward W Hook, MD]

Thanks for the aitional information.  I'm sorry to hear of the exposure but my assessment is unchanged- without penetration this was still a no risk exposure and your symtoms occurred too soon and are uncharacterisitic of the ARS.  I certainly cannot fault you for wanting to get tested however.  You could have a PCR test at this time and if your symptoms were due to ARS it woul be positve or you can wait until a week after the onset of your symptoms to test- either way, a negative test woul be indicative that your symptoms were not due to HIV.   EWH

[perhaps_unneccessary]

Doctor,

I have additional information to report. I contacted the man and asked him if he would be willing to test again, and he agreed. The rapid test reported a positive result, but he's still waiting for the results of the confirmatory test. At this point he admitted to me that he was not entirely truthful about always using condoms and that he had barebacked a week prior to our encounter.

This has made me a little nervous.

I'm going to go get tested next week just to put all of this out of my mind. I know that symptoms are awfully unreliable in diagnosing early HIV infection, but at a guess, just how uncommon would it be for the initial presentation to be a sudden onset 24-48 hour illness with high fever, muscle aches, and vomiting?

[Edward W Hook, MD]

Welcome to our Forum.  I would agree that it is far more likely that your symptoms are due to a gastroenteritis that ARS.  I would say this is the case for three reasons.  They are:

1.  Your exposure was no risk.  HIV is not spread without penetration and the simple act of getting a partner's genital secretions on you, even near a site such as your anus, is still no risk.

2.  Your partner said he did not have HIV and most people do tell the truth about such things.  

3.  Even when a person has symptoms precisely matching those described for early HIV (and as you point out, your do not), the odds are about 100 to one that they are caused by something other than HIV.

I would not worry an to be honest, see no reason for you to even test related to the exposure you describe.  EWH