Oral Sex - But Highly Symptomatic

Day 0: Received unprotected oral sex 3 times from 3 different CSW’s in India in one night. Am not circumcised and in late 30’s.

Day 1-4: Felt drowsy for next 4 days and had on/off what seemed to be heartburn but thought this was due to the all nighter I pulled during this “party” even though normally it does not take me so long to recover

Day 5-11: Recurring episodes of nausea, malaise, and pain in armpit/neck area that lasted for a few minutes and occurred variably throughout the day (lasted 7 days). Definitely felt like I was coming down with something.

Day 7-12: Woke up with stiff neck (difficult bending head down and also to the right). Applied ointment at night and saw good improvement within 3 days and nearly fully recovered within 5 days.  Also had myalgia in upper back/shoulder/neck during this time, which at times felt severe.

Day 12: Currently no major issues. Normally wouldn’t bother but these symptoms are worrying me.

1. Does this sound like ARS related meningitis?

2. Does this sound like ARS at all? I have read cases of ARS occurring as early as days after potential infection. Plus my immunity was low due to all night partying and alcohol, etc.

3. Even though oral sex is low risk, the one thing I do remember is that one of the CSW’s had very offensively smelly saliva (could smell it on my penis during and even afterwards). Is it possible that she had ulcers/sores which caused this bad smelling saliva, which in turn increased the risk?

4. Should I be worried and do I need to test?  Would you?

5. Could the heartburn symptoms have actually been esophageal ulcers?

6. Even if someone was to get infected this way, how could he scientifically prove it?  Nobody on this forum would believe him anyway.  

7. Is risk of 1/10000 or 1/20000 the same as zero?  If not, what factor could cause infection for oral insertive sex?

[Edward W Hook, MD]

Welcome to our Forum.  As you already know, 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.  Thus, even if one or more of your partners had HIV, your risk of infection is virtually zero.  

In addition, you may have missed our repeated statements that to worry about symptoms of early HIV is a complete and total waste of time.  The non-specific symptoms which are part of the so-called ARS are EXACTLY the same symptoms that are caused by numerous other "every day" viral illnesses.  In your own case, the symptoms you described, besides being non-specific, started earlier than would be expected for the ARS.  thus, you really have nothing to worry about.

As far as your specific questions are concerned:
1.  No, this does not sound like ARS-meningitis or, for that matter, ARS at all.
2.  See above.
3.  Neither bad breath, gum disease or oral sores change the fact that receipt of oral sex is virtually no risk for HIV.
4.  I see no medical reason for testing.  If you wish to do so for your peace of mind, that is another thing.
5.  No, not HIV-related esophageal ulcers which are seen in late, not early HIV.
6. this is a rhetorical question.  proof would start with knowing that your partner had HIV and that no other type of exposure, with anyone, had occurred.
7.  Effectively yes, this is the same as zero.

Take care. EWH

[illuminate]

Also wanted to add that I don't recall feeling feverish but am not sure since I never took my temperature.  Also had the occasional light headache during days 7-12 as well.

[illuminate]

Dear Dr. Hook,

Thank you for your prompt reply.  Just to clarify a few things:

1.  You mention that it is not ARS.  Is this due to the timing of the symptoms or the nature of the symptoms (or both)?  Regarding the timing, the symptoms from the 4th day were more like an indication that something was wrong, but the major symptoms (and severity of the symptoms) started on the 7th day, which is consistent with ARS timeframe, isn't it...?!

2.  What does primary HIV meningitis usually manifest as?  Can you have meningitis without fever and/or headache?  I have read reports (Dr. B. Walker) that indicate that primary HIV meningitis is often as high as 24% as a symptom.

3.  Does duration and intensity of oral sex affect the probability of infection in any way (i.e. longer duration/instensity versus shorter duration/intensity)

[Edward W Hook, MD]

1.  Both. The ARS typically does not start until 2 weeks or more follwoing exposure.  Furthermore, while your non-specific symptoms common to most viral infections included some of those included in the ARS, they did not fit the picture.
2.  Sigh.  You're having trouble getting by this, aren't you.  "HIV meningitis" describes the headache, stiff neck and other non-specific symptoms which accompany many viral infections.  To make the definition however you need a spinal tap.  You may have had mild viral meningitis.
3.  No

Hope this helps.  EWH