Oral Exposure

[inception76]

I am a 32 year married male. had unprotected oral exposure  with escorts - sucking of the penis for 10 mins. 1st exposure was 3.5 months before and the 2nd one was 3 months before. worried about HIV and had tests. tested negative on antibody and DNA PCR at 12 weeks past 1st exposure (roughly 10 weeks past 2nd)
13 weeks after 1st exposure (11 weeks after 2nd), I had all symptoms of ARS – fever ( 101.5), a little sore throat, body pain and tiredness. Body pain and tiredness were better the second day itself with tynelol and gone the 3rd day. Fever reduced on day 3 and gone on day 4. No tynelol after day 2. On day 1, I had dry cough which became productive cough on day 2. On day 3, I visited my Doctor who gave me Azithromycin Z pak. Cough reduced on day 4 after taking medicine. But there is still some productive cough though I have finished the course a week back.
3-4 days later, my wife also got similar symptoms – fever, very severe sore throat and  little body pain. She took tynelols on 2 days. On day 2, we went to Doctor who gave some steroids which helped with sore throat. No other meds after day 2. Fever was gone on day 3. Minor throat pain continued for 2-3 days. She also had dry cough which became productive cough. She still has little productive cough which is 8 days after initial fever. She had night sweats 2-3 days later ( no fever) for around 2 days ( not soaking though). These have stopped now.
Please note that I had intercourse with my wife only after 1st exposure.
1. Are these symptoms suggestive of ARS? Can we get ARS symptoms after  11 weeks? Is getting ARS symptoms this late not possible at all? Please tell me worst case scenario.
2. I am worried I have passed it on to my wife. But, as I have tested negative at 12 weeks past 1st exposure, I assume we are both clear. Please tell me worst case scenario.
3. Since I do not know other person’s status, I assume I need 6 months testing. Is this correct? I will test again at 3 month post 2nd expsoure.

[Edward W Hook, MD]

This will be your last answer.  Your wife should be seen by a gynecologist for her gynecological symptoms.  There are many possible causes. For me to guess what might be troubling her without communicating with her is inappropriate and silly.  STD is not a concern.  

I agree with your physician.  You do not need more tests, you need to stop worrying. EWH

[inception76]

Sir - I am willing to pay again or raise a separate question. Please tell me if I need to.

Since I have tested negative for herpes, Syphillis, Gonorrhoea and Chlamydia at the 3 month mark, what else could cause this? I am planning to meet my Doctor, but I just wanted to take your expert opinion on what other bacteria / virus/ other organisms that could cause these symptoms? The reason I am asking this is that My Physician has mentioned to me that no more tests are required for me for any other bacteria / Virus / anything else. Kindly provide your opinion on any thing else that can be acquired through sexual exposure which could have caused this . I will be grateful for your time. Thanks.

[Edward W Hook, MD]

Such symptoms could be due to STD but they also have many other possible causes.   Given the nature of your exposure, it is unlikely that these symptoms are due to an STD acquired in the context of the exposure you described

If you are worried, she should be seen and tested by a doctor or other health care provider.

This will end this thread.  EWH

[inception76]

Hello Dr. Hope you are doing well. I also tested for Herpes, Syphillis, Gonorrhoea and Chlamydia at the 3 month mark post 2nd exposure though I did not have any STD symptoms. There is 1 one symptom that my wife had. I thought I will clarify it with you. Her last but one period was very painful than the regular ones. Again, in her last period, she had abdominal discomfort 2 days before itself and this never happens for her. Similarly, her bleeding discharge was over on 2 days and there was no bleeding after that. Normally, she has light bleeding on day 1 and heavy on days 2 and 3 and light bleeding on 4 and 5. This period was very different.

1. Can any STD cause these symptoms? Please suggest worst case answer
2. I am worried much as we do not yet have children and I want her reproductive systems to be healthy.

Thank you sir.

[inception76]

Thanks so much for the prompt response

[Edward W Hook, MD]

The idea of a delayed immune response to HIV is an urban myth.  Your results are conclusive, really.  Testing at 6 months would be a waste of time, money and emotional energy.   EWH

[inception76]

Thanks Doctor for your prompt response.

I took another antibody test last week and it came back negative. This is on 15.5 days mark past 1st expsoure ( 108 days) and 13 weeks ( 3 months ) past second exposure.

I just have one question before I wrap this up. My wife has been having low platelet count for the past 2-3 months. I have been googling for reasons and one website said it could be due to omega 3 fatty acids( http://www.wisegeek.com/what-are-omega-3-fatty-acids.htm). This website also indicates that " Taking overly high doses may also cause the immunoresponse system of the body to become sluggish, which can lead to a higher risk of infection".

I have also been taking the same omega 3 tablets for around 6 months now ( http://www.gnld.com/store/Product.aspx?STORE_ID=1&CATEGORY_ID=1252&NAV_CATEGORY_ID=3230&PRODUCT_ID=11640 ).

My question in this - I understand that my results are conclusive as it way past 3 months for 1st exposure and 3 months past 2nd exposure. Could these tablets have slowed my immune response in any way that I have not produced the antibodies yet? Do I need to be tested at 6 months mark? Please accept my ignorance and my apologies for these questions.

Thanks for your time and help in this regard.

[Edward W Hook, MD]

ARS occurs 2-4 weeks following exposure.  

The 6 mlnth recommendation is overly conservative.  For all practical purposes all FDA approved, stanard HIV antibody tests  test perform comparably and provide accurate information on the presence or absence of HIV infection in virtually everyone at 8 weeks following exposure.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.   There is little for you to gain with a 6 month test.  EWH

[inception76]

Thanks for your prompt response sir. Just 2 more questions to calm my mind:

1. In worst case scenario, how late can ARS come? Please tell me worst case scenario.
2. Why is 6 months testing recommended in some case? My physician wants to test at 6 months. I understand it is recommened in high risk cases. But is not every situation high risk as we do not the status of the other person?

[Edward W Hook, MD]

Welcome to our Forum.  The exposures you describe did not put you at risk for HIV and you can be confident you do not have HIV based on your test results.  

Chances are your partners did not have HIV.  Most escorts do not.  Even in the unlikely situation that one of them did have infection, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  

furthermore, the tests for HIV are very, very good and you have repeated negative tests.   PCR tests are uniformly positive by 4 weeks following exposure and while not recommended for HIV diagnosis because of cost and problems with false positive results, negative tests at 12 weeks prove you did not get HIV. Similarly, antibody tests are definitive at 8 weeks and those tests are negative as well.  You do not have HIV. Two different but highly reliable types of test prove this.

The "symptoms" of the ARS are non-specific and are the same symptoms which are caused by many other community acquired viral illnesses.  You had something other than HIV as the explanation for your symptoms. That your illness passed quickly to your wife serves to confirm that this was one of the common, community acquired, non-sexually transmitted viral illnesses which are far, far more common than HIV.

Believe your tests.   You do not have HIV.  You do not need to be concerned and further testing is certainly not needed.  EWH