Need your help please

Hello Doctor. Thanks for taking my question. I am a 33 year old male out of Dallas, Texas. I had an exposure with an escort 7 weeks before and I am worried about that.

The exposure did not involve any vaginal or anal penetration. It mostly involved dry humping, rolling / rubbing our naked bodies against each other, me kissing and grabbing all her body parts ( no vaginal/ anal kissing), etc. I touched her pubic hair though.She gave me a hand job and while doing that her mouth was very close to my penis and many a times she acted like doing a blowjob. She was very close to kissing my penis and I am not 100% sure if she did kiss that. She also blew air on the penis while I was ejaculating. I am not sure if all of this transferred any saliva or blood from her mouth on to my penis. This exposure happened on 2 days.

I had the following symptoms:
1.Week 1 to 5 – Dry mouth and dry lips for a couple of days and diarrhea for a couple of days. Diarrhea was on and off
2.At exactly 5 weeks, I had fever and body pain which lasted only 1 day. Fever did not cross 99.7. My physician said it was bacterial infection based on CBC – WBC count of over 15 ( elevated granulocytes, normal lymphocytes) and I was put on Omnicef for 10 days
3.At 5.5 weeks, I had an enlarged lymph node on the left side of my neck and that still continues. Stiff neck also started at the same time which still continues
4.At 6.5 weeks, my dry mouth and dry lip symptoms came back. This time, I also have a burning sensation on my mouth which is due to some cuts on the sides on my lips. I do not see thrush on sores. I also have dry nose. I am not sure if this was due to Antibiotics course of 10 days
5.All through weeks 5 to 7 (at least 4 times), I felt chills on many days and my temperature was down t 98. I have never seen my temperature so low in my entire life
6.I have lost 10 pounds in the last 6 weeks, but I am also exercising ( not dieting)

[Edward W Hook, MD]

Welcome to the Forum. You have exceeded the word limit for posts and according to our rules, I should have you re-state your questions.  Instead, I will reply to your questions but please follow the rules of the site. they are there for good reason.

Before I address your specific questions, let me make a few general comments.  The exposure you describe was virtually no risk for any STD and no risk at all for HIV.  HIV is not spread by touching, masturbation, or saliva.  Other STDs may be, at least in theory but neither of us have ever seen a case and if it happened with any meaningful frequency I am confident we could no.  Further, you have now been tested.  Tests are the final word.  The reason for the testing is to help assign causes to non-specific problems.  In your case, your tests are negative, thus you should not be worrying about STDs, including HIV. With these introductory comments let's address your questions:

1.can HIV be transmitted by my exposure?
See above.  No.  

2.Can I get HIV from her hands if she had given a handjob to someone else just before me and did not clean up fine?
HIV is not transmitted by masturbation, even directly when a partner is infected.  There is no evidence of this and people have looked hard.  Your receipt of masturbation was a no risk event.

3.Are my symptoms worrisome (or) suggestive of HIV? I am especially worried about fever/ body pain, Chills, lymph node, dry mouth, stiff neck and weight loss
No, your symptoms are non-specific and with the passage of time there is less and less, not more to suggest that they are not related to HIV.  

4.Do I need further testing (or) Can I move on with my life?
No, your testing is now conclusive. You do not need further testing and I would encourage you to move forward with your life.

5.Is window period for same for HIV 2 as HIV 1? Is HIV 2 prevalent in Texas?
HIV2 is rare within the U.S, including Texas.  Had you acquired HIV-2, the tests you had would have detected it.  The window period is the same for HIV-1 and -2.

6.If someone has real ARS symtoms (symptoms), how much time does it take to test positive on Antibody test?
If a person has ARS, their blood test are positive within a few days of the beginning of symptoms.

7.Can ARS come after 5 weeks?
It is said that ARS can occur as late as 6 weeks but this is exceedingly uncommon.  You have no reason to worry that you are having the ARS- your tests prove this is not the cause of your symptoms.

I hope these comments are helpful.  EWH

[perufan]

Sorry for extending the question.

Good news is that I tested for all STD’s at week 5 and it came back negative. At Day 48, I tested for HIV Ab and it came back negative.

1.can HIV be transmitted by my exposure?
2.Can I get HIV from her hands if she had given a handjob to someone else just before me and did not clean up fine?
3.Are my symptoms worrisome (or) suggestive of HIV? I am especially worried about fever/ body pain, Chills, lymph node, dry mouth, stiff neck and weight loss
4.Do I need further testing (or) Can I move on with my life?
5.Is window period for same for HIV 2 as HIV 1? Is HIV 2 prevalent in Texas?
6.If someone has real ARS symtoms (symptoms), how much time does it take to test positive on Antibody test?
7.Can ARS come after 5 weeks?

Thanks for your time.

[perufan]

Thanks Doctor for the super prompt response. I have a last few questions :

1. Is my testing at 48 days conclusive? Many sites say it is 12 weeks
2. I am sorry that I am not able to understand your response to # 3. Most of my symptoms have come after week 5 only
3. For # 6, is it a few days or a few weeks? What is the maximum time it takes after ARS for detectable antobodies?
4. For me to be 100% convinced that it is not HIV, when should I take a final test?

Thanks for your time again

[Edward W Hook, MD]

1.  Negative tests following a NO risk exposure confirm that you do not have HIV, as i said.

2.  These symptoms are non-specific and could be caused by lots of things other than HIV, including anxiety. You were tested for HIV AFTER the symptoms began. If the symptoms were due to HIV, your test would have been positive.  

3. Question already answered- a few days

4.  I cannot comment on what it will take for you to be convinced.  I can only tell you that from what you tell me I am confident you do not have HIV.  EWH

[perufan]

Sir - Thanks again. Sorry for some more questions. I promise I will stop with this.

1. In case of HIV acute infection, do you normally see general lypmhadenopathy? Do you see only 1 lymph node enlargement as in my case?

2. My body feels chill a couple of times during the day for the last 2-3 days and a couple of days last week ( no shivering / fever though). Does HIV ever cause this low temperature after initial fever? I have never felt chills in all my life and go without a jacket even when the temperature is in 30's

3. Normally in acute infection, do all the symptoms come at the same time ( or) do they spread across and come one after another over 2 weeks? Also, does one symptom stays and goes (or) is it on and off over the 2 weeks duration?  

4. Regarding handjob, please confirm that she cannot transfer it to my penis through the semen that she may have on her hand through a handjob to someone else.

5. Last question on anitbody creation - Dr Handsfield has mentioned in this post that it will take 1-2 weeks for antibodies to test positive after symptoms. Please tell me whether it is days or 2 weeks. I am harping on this question so that I can time my next test and put all of this behind my back. Thanks a bunch for your time, help and patience on all this.

http://www.medhelp.org/posts/HIV-Prevention/ARS-Symptoms/show/1477486

[Edward W Hook, MD]

Your anxiety driven questions suggest that you are having trouble accepting my assessment.  I cannot help that but I also cannot engage in a prolonged, repetitive exchange because you are anxious and/or feeling guilty.  These will be the last answers.  None of them in any way change the FACT that your tests have already proven that you did not get HIV form the exposure you described.

1.  The lymph node swelling of early HIV infection is generalized and not typically limited to a single lymph node or even a single area.

2.  Feeling a chill is a non-specific finding and is in no way the same as a measured temperature.  Fever is part of the signs described with early HIV, low temeprature is not.

3.  The symptoms of early HIV typically have their onset within a day or two and are not spread over a period of weeks.

4.  Already answered in number 2 of my original answer.  No need to repeat the answer.

5.  Dr. Handsfield is being conservative and tests for HIV are typically positive within a few days and certainly a week of the onset of early HIV symptoms.  

this thread is now over.  EWH

[perufan]

Thank you very much sir. I am really grateful to you and this forum