Should I Be Concerned?

I am a 32yo gay male, have not had anal sex in at least 12 months (always protected in any case), but most recently have engaged in unprotected oral sex in late November January 2nd, 3rd and January 14th - each instance was with guys via the internet (in 20s-30s age-wise) I do not know so much about but they did not appear to be drug users and didn't make requests for anything more unsafe than unprotected oral sex & seemed conscious of risks.

On January 16th, I started to get a fever (around 100 but eventually would spike as high as 103.5), very sore throat, a very large swollen gland on the same side of the neck as the sore throat (at least an inch)(it was initially very painful and tender but decreased), a few other glands popped up behind my ear and on the same side of my neck. Fever was very difficult to control, with tylenol it would go down to 100 and I had night sweats each night. Pretty bad headaches, no rashes. I did lose about 7 lbs but was not eating much because of the painful throat.

After 2 days, I went to my family doctor, he said perhaps I had strep throat, gave me antibiotics. 4 days later, I was just as sick and fever just as strong so I went back to the family doctor and he suspected mono - but did the following tests: Monospot, HIV Elisa and Western Blot. All came back negative. He had another doctor examine my throat and this doctor said that my throat was highly ulcerated, similar to canker sores on my throat & lingual tonsils. Kept me on antibiotics, added steroids, & I have begun to improve, with no fever, but my throat is somewhat sore.

This doctor recommended more mono tests but also HIV PCR and p24 test as he said he was suspicious of acute HIV given my difficult fever and the throat ulcers...these tests will take 7 days so in the interim, I am obviously anxious and would appreciate your thoughts on my level of risk, & given the dates of my encounters, how much comfort I can take from the negative tests for HIV and that this is not ARS?

[Edward W Hook, MD]

Welcome to our Forum.  I can completely understand your concern, and applaud your doctor for being thorough. while you are waiting for your results however, I would not worry.  If you have acquired HIV through oral sex would will be the first person to have done so that I have ever encountered in my career which spans the duration of this epidemic.  Oral sex is just not a meaningful risk factor for HIV.  I suppose that someday, somehow, it will occur but as I said, when it does, it will be the first such case I will have encountered or even heard of.  

There are many, many viruses that can cause the sorts of symptoms you have. Again, I applaud the approach your doctor took.  He did the right tests, treated the thing that could have been treated (strep) and tested for the other, easily tested for problems such as mono.  

Further, there are a few other factors which make it unlikely that you acquired HIV from the exposures you describe.  First, while sore throat can be PART of the ARS, other symptoms such as muscle aches, diarrhea and rash are also an important part as well.  Second, the timing of your illness is only compatible with the ARS for your contacts at the beginning of January- the symptoms began too soon after your mid-January contact to be ARS and on the late side to result from your contact in late November.

I hope these comments are helpful.  I really am most comfortable in telling you that your PCR results will be negative. EWH

[nycjoe]

Dr. Hook,

Thanks for all the helpful information - will definitely help me be less anxious in this interim period. I am generally quite rational about these things but the doctor's concern got to me.

A few clarifying points just to be sure - and forgive me in advance if there were not worthy of comment in the first instance but they will just ease my worries:

(1) The doctor's stated chief concern was how intense and long-lasting my fever was - said it was not so normal for someone of my age to keep such a bad fever for so long and it usually indicates something quite acute....

(2) I did have headache/muscle ache but really thought it was just from the fevers being so exhausting and dehydrating; same with a little diarrhea but I was eating almost nothing and I have a bit of irritable bowel to begin with...

(3) On the question of oral sex risks, it is quite possible that I had a canker sore in my mouth during one of the encounters - does that change anything if the person did ejaculate in my mouth? I presume no but have to ask.

Apologies again if this are not worthy of comment but just want to be sure.

Thanks.

[nycjoe]

Oh and I forgot - given the timing of my early January encounter, does the negative elisa and western blot mean anything or just too soon? had them after about a week or so of being so sick...

[nycjoe]

The elisa/western blot test timing was about 21 days after the last encounter...

[Edward W Hook, MD]

Directly to your follow-up questions:

1.  You had a tougher than "average" illness.  that does not equate to ARS.  The course of your illness is not worrisome.

2.  see above.

3.  No, the presence of a canker sore, gum disease or other oral health problems does not change my assessment.

At 21 days a standard ELISA would detect about 2/3 or recently acquired HIV infections.

Hope this provides further comfort.  EWH  

[nycjoe]

Thanks kindly for your time, patience and advice. I will let you know how the remainder of tests go.

[nycjoe]

Not sure what this adds and I only have basic info - but my family doctor just called and said additional bloodwork that he did looked just fine, good blood counts, etc but that I did have something called CMV, which he says  may have been the cause of my respiratory issues/recent illness....and that was all he said in the voicemail....does that complicate your assessment?

[nycjoe]

Read up a little on CMV and it seems I may have the CMV version of mono based on my symptoms - seems it is somewhat unusual for someone to have symptoms from CMV - since I tested negative on the ELISA test I obviously do not have any long-standing HIV infection but does getting sick with CMV as I apparently have ever go hand-in-hand with acute HIV infection?

[Edward W Hook, MD]

You continue to over react.  CMV causes over 25% of the syndrome we call mononucleosis.  Havng CMV does not in any way change (Increase) your risk for, or the probability that you have HIV.  Please relax.  You need to.  EWH

[nycjoe]

Sorry for any overreaction - I was literally pretty clueless about CMV and my doctor had left the message and already gone home for the evening. I had no idea that it causes 25% of mono cases so in the end I feel better as at least there is a very logical explanation for how ill I have been - thanks for the advice and patience.

[Edward W Hook, MD]

Gald to help. Take care. EWH

[nycjoe]

As you predicted, all HIV tests negative. Thanks so much for the advice.