ARS and risk from oral on escort

[helpmeoutplease1]

Hi Doctor,

thank you for the forum, it has been a place of comfort in the past and I am hoping you can calm my fears.

I have had 4 encounters with female escorts over a year (or since my last definitive HIV test). All vaginal sex was

protected.

1x I received unprotected oral.

About a week ago I had an encounter where I gave the escort unprotected oral.

Exactly 7 days after the encounter I started to become ill, beginning with a sore throat, swollen glands, and body

aches. I was worried that I had acquired oral  gonorrhea so (and I know you don't recommend this) I took 500mg of

Cipro I had laying around. The next day my fever grew and for 3 days now has fluctuated from  about 98.9-101.2.

My neck and back are very  stiff and I have developed a cold (sneezing, runny nose) and cough as well. Given the

symptoms, time frame, and  exposure do you think I may have contracted HIV? Or something else from this

encounter? Should I be worried at all? What could explain the stiff neck and back? (BTW, the sore throat pretty

much cleared after the CIPRO).

Thanks for any advice. I appreciate your work.

[Edward W Hook, MD]

No, I see no need for a throat culture at this time.  The probability that it would be positive is vanishingly low.  EWH

[helpmeoutplease1]

Thanks Dr...I will try to get this out of my mind, your comments were reassuring.

As far as testing goes, being that my sore throat went away after a day and the

low probability of gonorrhea (or other STD's) transmission from male-to-female oral, do you think

I need to have a throat culture or other STD test from this encounter? Thanks, and that will

be it, I promise.

[Edward W Hook, MD]

Welcome to our Forum.  While your question relates to the possibility that you have recently had the ARS, I can't resist also commenting on your oral gonorrhea concerns too.  

First things first.  Could this have been ARS?  Short answer = no.  Why?  well for starters it is unlikely that your partners had HIV and, even if they did 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.  

Secondly, it is also most unlikely that your symptoms were the ARS.  The symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much, much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In your own case, the symptoms you describe are not all of the symptoms of the ARS which typically also includes GI symptoms, rashes, joint aches and high fevers.  The headache and neck/back stiffness you mention are typical of many viral illnesses.  

As far as where you got it, you are as likely to have caught whatever it was that you had when you shook hands with someone as during the sexual encounter you describe.  

I would urge you not to worry at all about HIV related to the encounter you describe.  Personally, I see no need for testing either.

Now for your sore throat.  If you are going to self medicate, at least use a better medicine.  It is unlikely you had gonorrhea since most gonorrhea of the throat is asymptomatic.  If you had gonorrhea, at least 10% and probably more gonorrhea in the U.S. are now resistant to cipro and failure rates for quinolone-type antibiotics like cipro are rather high.

Hope you find these comments helpful.  EWH