Risk assessment / ARS symptoms

[gophish11]

Hi Doctor,

While I know that symptoms are no way to diagnose HIV infection, I have most ARS symptoms 8 days after exposure, which are worrying me.  My exposure is one that I know many would call "low-risk" and I will get tested at 6 weeks.  Until then, here goes:

Last Friday night, I met a random guy on craigslist to hook up.  I've been in a monogomous relationship with my girlfriend for 8 years, save the periodic (maybe 1 per year) lapse where I'll hook up with a guy to explore bisexual tendancies.  I test periodically and had a negative test last August, so it's only this one encounter I'm worried about.  We swapped unprotected oral, performed frottage on eachother (no condom) and I performed insertive anal on the other guy, with a condom and no signs of breakage.  He said he tested neg. back in December.  He also tried to insert into me (with condom) but couldn't stay hard.  I had contact with his semen with my hands and licked some off his stomach, and other than that there would have been precum while doing oral and frottage.  He didn't "penetrate" me, just some rubbing of his penis head on my anus.

I had a sore throat all week.  On Friday I was feeling lethargic and had swollen lymph-nodes in my throat and the sore throat persisted.  I woke up Saturday morning feeling fine, and actually went on a 30 mile bike ride (I felt that good).  By Saturday night (last night), I was feeling very nauseous, and was throwing up by 9pm.  I spent 4-5 hours last night with bad diarrhea and vomiting, which felt much like a very bad case of food poisoning.  Could not keep so much as a sip of water down.  By 10pm I had a 101.3 degree fever, which is now (Sunday AM) at 100.3.  I was trying to convince myself that it was food poisoning, but I've never had a fever with food poisoning.  Now I'm hoping that it's the flu, but the timing of the onset of symptoms makes it seem like too big of a coincidence, and I'm extremely fearful now that I have been exposed to HIV.

[H. Hunter Handsfield, M.D.]

I agree your symptoms are typical for norovirus.

Thanks for the thanks.  Take care.

[gophish11]

Thanks again Doctor.  My fever broke last night, but GI symptoms persist.  I've just recently learned about the Norovirus strain that's going around and it seems that's what I came down with.  I think it's just the timing of onset of symptoms that was quite startling.  You are correct - no rash, and my sore throat lasted between last Tuesday-Friday and was all but gone by the time the rest of my symptoms showed up.

Again, I greatly appreciate all of your help!

[H. Hunter Handsfield, M.D.]

Six weeks is definitive for the stand-alone antibody tests.  The duo test (for both HIV antibody and p24 antigen) and other combinations of direct HIV and antibody tests can be reliable at earlier times.  See this thread:

http://www.medhelp.org/posts/HIV---Prevention/RNA-and-oraquick-swab-test-/show/1891685

[gophish11]

Thank you so much for the thorough and thoughtful answer, doctor.  I really appreciate it!

Would you say that testing at 6 weeks would be definitive?  Are there any other types of HIV tests that I can seek out that would give a reliable result at 3-4 weeks?

Thanks again!

[H. Hunter Handsfield, M.D.]

Welcome back to the forum. Thanks for your question.

You are correct that symptoms are always poor predictors of acute HIV infections, primarily because ARS symptoms are pretty much identical with those of many other infectious and inflammatory conditions.  In your case, I'm quite confident ARS isn't the explanation of your symptoms, for several reasons.

First, the symptoms are very typical for viral gastroenteritis; contrary to your past experience, fever is common in gastroenteritis.  (And by the way, it isn't influenza either, which also doesn't cause GI symptoms.)  Second, ARS doesn't usually cause nausea, vomiting, or diarrhea.  Third, although sore throat could be caused by HIV, of course that's an exceedingly common symptoms caused by innumerable viruses, allergies, etc.  Additionally, it seems to have started too soon: if you've had sore throat "all week", it must have begun within a couple days of the sexual exposure, which is much too soon.  Fourth, you don't mention skin rash, which usually is present in ARS (70% of people with ARS have all three among sore throat, rash, and fever -- and without GI symptoms).

And then there's the exposure.  You correctly surmised it was low risk, both because your partner probably doesn't have HIV (most people tell the truth when asked directly, and research has shown that people who solicit partners via the internet are truthful in posting the STD/HIV status); you used a condom (good move!); and the other details of the events weren't likely to result in transmission even if your partner was infected.

Is there some small chance you acquired HIV?  Yes -- but truly very small. I expect your GI symptoms to clear up promptly -- if they don't, or if you get higher fever or bloody diarrhea, get examined right away.  (These are not signs of HIV, just that the GI infection is severe and might need antibiotics.)  For reassurance, I would recommend you follow through on your plan for HIV testing -- but you can expect it to remain negative.  For still more prompt reassurance, you could also speak with your partner.  If you explain your symptoms and concern, perhaps he would happily have another HIV test; if still negative, your worries would be over.

I hope this has been helpful.  Best wishes and stay safe--  HHH, MD