high risk

Thank you for answering my questions Doctor. On July 2 I had unprotected insertive anal sex with another gay man. He says he is "sure" he is negative and says i'm the only guy he's been with but i don't know if i believe him. On July 10 I vigorously rimmed another man for 15-20 mins, and engaged in protected insertive anal sex. On July 13 I woke up with a headache, fatigue, chills, rapid diarrhea, and nausea. On July 14 I went into urgent care and got my temperature taken, it was 98 degrees despite the doctor saying my skin felt hot. So I can't say for sure if I had a fever. They tested me for gonorrhea and chlamydia and both came back negative. They tested my white blood cell count and lymphocytes and the white blood cell count was up, where as lymphocytes were neutral. He deduced I had a bacterial infection (infectious diarrhea) and prescribed ciprofloxacin twice a day for 7 days. I took one pill that night, and woke up feeling tremendously better. I was surprised how well I felt by July 16, like 90% better. I finished the antibiotics even though I felt fine. I contacted the guy who i had unprotected sex with and he says i'm the only guy he's been with and he's sure he's fine, and that he wants to get tested too because he's suspicious about me but that he feels fine on his end. I can't help but take what he says with a grain of salt, though i have been pressuring him to get tested and show me the results. I tested negative exactly 23 days post exposure, with a third generation rapid test. I'm willing to get a PCR test to calm my nerves, but it'll cost a couple hundred dollars. Anyway, what can you tell me about my symptoms, a connection to ARS, my negative test at 23 days, and whether you think I'm infected or not. I'm very very scared and i've been thinking about HIV nonstop.

[Edward W Hook, MD]

Welcome back to our Forum.  I'll try to help.  While there was clearly some risk associated with your July 2 exposure and your flu-like illness 11 days later is worrisome, the overall the risk is low.  Let me tell you some of the reasons I say this:

Your partner has repeatedly told you he is not infected and that he wants you to be tested all suggest that he is not infected.  If he were infected, why would he want you to be tested?

Even if he was infected, as the insertive partner, the risk of infection from a single exposure is less than 1% (estmated to be about 1 in 200).

Your negative test 23 days post exposure and almost two weeks after your flu-like illness is also strong evidence that you were not infected either.  If your flu-like symptoms had been the ARS, we would expect your test to have been positive less than a week after your symptoms began. that your test was negative indicates that your diarrhea was not ARS.

Putting all of these facts together, it is most unlikely that you acquired HIV and this is not something to worry about.  You can definitively prove you did not get HIV from your exposure if your partner has a negative HIV test at this time or if you have a negative HIV antibody test at 8 weeks after exposure.  I see no value to you of getting an HIV PCR test at this time.

I hope these comments are helpful and reassuring.  EWH

[vinnyboy]

By the way, Doctor, I'm usually a very cautious person when it comes to sex. I always wear a condom, except for July 2, and I only top. I even wore a condom on July 2, but I pulled it off because I was done having sex and then he got ontop of me and initiated the barebacking. It's my fault for not stopping him, and it's something i completely regret.

[vinnyboy]

Thank you Doctor. I have something on my mind that I want to run by you. Is it likely I got a bacterial infection from rimming on July 10? Could that bacterial infection be the cause of my symptoms on July 13? I responded very well to the ciprofloxacin. The symptoms cleared up in two days. If i had ARS would an antibiotic make it go away?

[Edward W Hook, MD]

Gastrointestinal illnesses, leading to diarrhea, can be acquired by rimming.

the ARS would not respond to antibiotics. EWH

[vinnyboy]

I have an update. 29 days post exposure I got an HIV PCR and antibody test. I got the test results back today and they all came back negative! How much credence can I put into these results?

[Edward W Hook, MD]

The combination of these two results is defintive. You did not get HIV from the exposure you described.  no need for further testing.  Stay safe- EWH