HIV Infection-Primetime

[primetimemsc]

I received unprotected oral sex (penis and anus) from a woman a week ago.  The was no vaginal intercourse because the woman was her period. This woman allowed me to ejaculate in her mouth. It is now day 7 since the incident and I have a low grade fever and generally do not feel well. My forehead perspires and my temperature ranges from 97 to 99. I am hypertensive so my blood pressure is elevated 185/120 (untreated) I took my blood pressure meds this morning and am now 120/75 and still do not feel well. My questions are:
1) are my symptoms consistent with HIV infection but too early to experience relative to the timing of my exposure
2) When is the earliest I can be tested where the results would be meaningful?
3)What is the most sophisticated/reliable test available?

Quite frankly if you were in my shoes what would you do?

[H. Hunter Handsfield, M.D.]

The mouth is a rare source of HIV transmission.  Among other things, saliva inactivates HIV.  Transmission by rimming (oral-anal contact) has never been described, and oral to penile transmission is very rare -- some experts believe it never occurs at all.

You don't say anything about your partner, but if you are in the US or other industrialized country, and if she is not at especially high risk (commercial sex worker, injection drug user, etc) then the chance she has HIV is very low, probably under 1 chance in 1,000.

So on those factors -- low likelihood of HIV in your partner, virtually no risk of transmission even if she had it -- it is extremely unlikely you are at risk for HIV.  Your symptoms make no difference one way or the other.  Even when people have symptoms typical for acute HIV infection, usually something else is the cause -- since the identical symptoms are caused by many other minor illnesses.  And your symptoms don't even hint at HIV anyway.

To the specific questions:

1) No, your symptoms do not suggest HIV; and you are correct that it's too early, since acute HIV symptoms don't start before about 10 days after exposure.

2,3) From the standpoint of risk assessment and symptoms, you do not need HIV testing at all.  But clearly you should be tested for its psychological benefit; most likely you will need the reassurance of a negative test result.  (This is not "code" to suggest I really believe you are at risk.  I do not.)  If you decide to be tested, I urge you to wait until 6-8 weeks and have a single standard antibody test.  The tests that can be done earlier (e.g., a PCR test for the virus itself) can be positive as soon as 10 days, but they carry a chance of misleading, false positive results.

So as for the last question, what would I do?  Knowing what I know, I would not be tested and would continue unprotected sex with my wife.  So don't lose any sleep over this.  You really had a very low risk sexual exposure and almost certainly did not catch HIV.  All is well.

Good luck--  HHH, MD

[primetimemsc]

Thanks for your answer. Please excuse me because I asked another question and did not direct it yo you. However I do have another question: My blood pressure is rather high and I do not feel well. I understand that the elevation in BP is probably because of my worry but I would like to know if...and only if i was exposed is elevated BP related to seroconversion in any way?
Big Thanks!