Puzzling Symptoms...

So...I had a series of protected sexual relationships about three/four weeks ago, two episodes were just protected anal, the other protected anal and I also performed unprotected analigus. April 30, I woke up with a slight fever, lower abdominal gas and bloating and diarrhea, but no upset stomach. I was tired and stayed in bed the 30th and 31st. The diarrhea has never been more than once or twice a day, if that, except for today. There was no rash that I know of. Monday the 2nd I went in to the doctor and he said I just had a viral something or other, and to jump start my bowels with a liquid diet, moving to more solid foods. He said the nodes in my neck were slightly enlarged due to nasal drip, which has since turned into a terrible cough that is so strong at times it makes me gag and depending on the cough, have a hard time making it productive. That Tuesday the 3rd, the fever was gone and hasn't returned, but the diarrhea has lasted more than a week. It's not chronic, but persistent.  I went back to the doctor two days ago, and he took a stool sample to see what he could see, but he asked me if I had been exposed to any autoimmune diseases, and my red flag went WAY up. I know protected sex is just that, protected, but what if when taking the condom off, I got some blood on/in my urethra? Do these symptoms relate to ARS? Should I be worried? It's the weirdness of the continued diarrhea, and his seemingly pointed question that is throwing me off. The nurse called today and said my lab results came back normal, and I ran to the bathroom four times today... I am on Lomodil, but I'm worried I've contracted HIV, and the diarrhea and night sweats (due to the coughing as I lay down, I thought) are my signs...If not, what could it be, especially when the stool labs came back clean? Any insight would be wonderfully helpful!

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Bottom line:  no HIV, but you may have an intestinal infection from your sexual exposure.

Analingus is just about the highest rist sexual activity there is -- not for HIV (probably little or no risk) nor other STDs, but for enteric (intestinal) infections.  Did you tell your doctor about that sexual exposure?  If not, you should phone him promptly and tell the entire story.  Any number of intestinal infections can be acquired that way, some of them difficult or impossible to diagnose unless the provider knows to test for them.  Given your symptoms, I would be concerned about parasitic infections in particular, such as giardiasis or (less likely) amebic (amoebic) dystentary.  Other considerations are campylobacter, cryptosporidium, salmonella, and shigella (bacterial dystentery).  And probably other possibilities I'm not thinking of at the moment.

But definitely you were not at risk for HIV, which probably is not transmissible by analingus and certainly not through condom-protected anal sex, assuming the condom remains intact.  And HIV does not cause the sort of gastrointestinal symptoms you have, at least not by themselves.  You also are at little or not risk of other STDs, and no STDs -- aside from the intestinal infections -- are likely from this sort of exposure.

If you gave the exposure history to your doctor, then consider asking him about the infections I mentioned; and if not, tell him now.  Please let me know how that works out.  In the meantime, you can be confident HIV is not the issue here.

Regards--  HHH, MD

[irishells]

Thank you for your help...I will discuss the situation with him. One final question...You mentioned that HIV does not cause the sort of symptoms I have in isolation. What are they generally seen with? Fever? Rash? What else? Is my cough any consideration?

[H. Hunter Handsfield, M.D.]

The three most common symptoms of ARS are sore throat (usually quite severe), fever (usually 101F or higher), and a body-wide non-itchy skin rash.  A number of other symptoms also are common, but those 3 are the main ones; 70% of patients with ARS have all three.  Diarrhea can occur, but not as the main or only symptom.  Cough usually does not occur.

Let me know what your doctor says.  Until then I won't have any other comments or advice.  Really, HIV simply is not a serioud consideration here.

[irishells]

One other question, which I'm sure will come up in the conversation with my doctor. I'm sure he'll ask me if they other person was equally symptomatic. Would he even have the same symptoms, or is it possible they might not know they have any of the diseases you mentioned earlier? In other words, can you have giardiasis, amebic (amoebic) (amoebic) dystentary, campylobacter, cryptosporidium, salmonella, and shigella (bacterial dystentery) without even knowing it?

[H. Hunter Handsfield, M.D.]

With the exception of shigella, all those conditions are commonly carried by people without symptoms.