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Acute viral syndrome?
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Acute viral syndrome?

In early December one night I came down with a fever and a light headache, and a day later my temperature was above 103 degrees, so my boyfriend took me to an urgent care facility, where I was given antibiotics and ibuprofen.  They tested me for flu and strep throat, both of which were negative.  They sent me to the emergency room.

The ER determined that I had viral pharyngitis, though they couldn't say what virus.  They ruled out mononucleosis.  They made no comment about the sores on the inside of my cheeks and my inflamed gums.  My only symptoms appeared to be the white-yellow sores on the inside of my cheeks, the inflamed gums, the high fever, and swollen lymph nodes just under my jaw.  My pulse was high and this was attributed to the fever.

A week of antipyretics later, I had no sores and no headache.  Three weeks later, however, my pulse was still high (it is normally about 60; it was then between 90 and 110) and I went to the ER again.  An echocardiogram was done and they found I had a pericardial effusion.  I was instructed to take 400 mg ibuprofen three times a day and to return for a follow-up.

My blood work was referred to as "great" by the doctors on both occasions, i.e. at the time of the fever and three weeks later when I had the echocardiogram.

It is now 5 weeks and a few days later, and my pulse is still high (about 72 sitting/resting, and up to 100-110 walking around).  Additionally, last night I found a hard lump about the size of a pea about an inch from my chin, above my jawline.  I understand that this is probably a swollen lymph node.

My boyfriend and I have a monogamous relationship, and engage in unprotected oral sex (only) on a regular basis.  However, both of us tested negative for HIV in early October, which was when we began seeing each other.

What concerns me is that my pulse is still high and that I now have this swollen lymph node on my face.  If my boyfriend has HIV, I could have been exposed to it anytime between October and November and AVS would have manifested in early December.  Additionally, I was given no indication as to what virus could have caused my symptoms (diagnosed "viral pharyngitis"? -- yes, thanks doc, I have throat pain and no, it's not responding to the antibiotics; but what IS it?).

I'm going to get tested tomorrow and will have results in two weeks, but the possibility my boyfriend might have HIV and that either he lied about the test or that the test lied about him is causing me a serious mood.  I'm terrified.  Can anyone offer me some insight into the possibility that I had AVS caused by HIV?

Does anyone know what percentage of cases of AVS present with the maculopapular rash that I didn't have?

And what about the pericardial effusion?  Why hasn't it gone away yet?

What could cause the lymph node above my jawline to become larger?

Could this have just been an infection by a typical virus--an enterovirus of some kind or something?  And would that be consistent with BOTH the mouth sores and the effusion?  Would it be consistent with the new swollen lymph node?
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173692_tn?1371540094
"unprotected oral sex (only) on a regular basis." You've never had a risk of contracting HIV. Keep working with your doctor your symptoms have nothing to do with HIV.
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Avatar_m_tn
Thanks Teak.

I'm confused.  I read multiple times on multiple pages that unprotected oral sex carries a risk of transmission.  Seminal fluid carrying HIV may have been in my mouth.  Supposing I brushed my teeth moments before, it could have gotten into abrasions on my gums, correct?

A note:  I did not allow my boyfriend to ejaculate into my mouth.
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173692_tn?1371540094
What you read was incorrect and not up to date.

From the International HIV Prevention Forum.

5 - Finally, in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?  I TOTALLY AGREE.

Best wishes,
Dr Jose Gonzalez-Garcia
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Avatar_m_tn
Thanks again, Teak.

As a precaution I will still confront my boy about his testing habits, past sexual encounters and so on... and still get regular tests myself...

Not to overpost or to insult you, though:  I just wish I knew WHY you and Dr. Gonzalez-Garcia consider it a zero risk activity.  What does that mean?  I thought that (especially as HIV infection amongst North American gay men is on the rise) nothing was zero risk, aside from holding hands wearing latex gloves?

And what do you mean by "not up to date"?  Are there recent studies I can look at for reassurance?
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173692_tn?1371540094
Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:


Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

In June 2002, a study conducted amongst 135 HIV negative Spanish heterosexuals, who were in a sexual relationship with a person who was HIV positive, reported that over 19,000 instances of unprotected oral sex had not led to any cases of HIV transmission.3 The study also looked at contributing factors that could affect the potential transmission of HIV through oral sex.
DEL ROMERO et al. (2002) Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS, Vol.16, p. 1296 - 1297

by Edward W Hook, MD  , Dec 11, 2009 10:08PM
No to both questions.  Herpes is not present in saliva.  Herpes is spread by direct contact.

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,even if you have blisters or sores.  EWH

by H. Hunter Handsfield, M.D.  , Dec 18, 2009 10:28AM
There is no debate (among experts) about the HIV risks associated with oral sex.  The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way.  Among experts, it's a semantic issue about using terms like "no risk" and "very low risk".  There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
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Avatar_m_tn
Teak, for the win.  Thanks.  I appreciate your effort a great deal.  I find comfort in all of this and I will try to use it for my own further education.

... of course, I'm still going to get tested, and I won't feel totally in the clear until months from now if my tests continue to be negative.  But I am, to a great extent, more relaxed.

I can say this of my scare:  I am much more aware of the crisis and I feel a renewed desire to do my part to help.
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