Worried about HIV and Herpes

Doctor,

I have no current STDs. About 2 weeks ago I had vaginal sex with a sex worker. I wore a condom and don't think it broke but can't be sure. 7 days later I started having apparent herpes symptoms: Mild fever, headache, tingling/burning in genital area, enlarged glands in throat, armpits, and groin (though I don't know that I ever got any sores). These are all pretty much gone now though I'm having some soreness in my throat and periodic shortness of breath. Not sure if this is the best thread since my questions are about multiple problems but here they are:

1. Could these symptoms in fact be herpes or could they be something else (like HIV)?
2. How likely is it that HIV could have been transmitted given that Herpes may have been present?

Thanks for your help

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  It certainly sounds as though you had some sort of systemic, probably viral illness (presuming you did not take other medications and don't have other known underlying health issues) a week ago and that is may (or may not) be related to the exposure you describe.  Since your exposure was condom protected, your risk as actually quite small and my guess is that this is not an STD but something else you caught in the course of normal, everyday life coincidental to your sexual exposure.  The possibilities are considerable.  Since I am an STD/HIV specialist, let me work through the STD-related possibilities, even though I personally think it is doubtful that this is behind your recent illness:

Herpes.  While the onset of your symptoms is compatible with HSV, typically first episodes of genital herpes do have lesions associated with them and the symptoms tend to last longer than your symptoms- 2-3 weeks on average.  Blood tests for herpes are of limited value.  Should the symptoms recur, I would look closely for lesions and, if present request that a culture or PCR test be performed.  

HIV. Heterosexual HIV is rare and the onset of the so-called acute retroviral syndrome typically occurs more than 2-3 weeks following exposure, not at 7 days.  Again, a statistically unlikely possibility.  If your symptoms were due to HIV, a test taken a week after the beginning of symptoms would almost certainly be positive.  

Mononucleosis.  "mono" is caused by at least two different viruses, Epstein-Barr virus or CMV.  Both viruses can be transmitted by close (including sexual) contact.  Mono tests check only for EBV.  Your symptoms are good for this.  Making the diagnosis with a blood test would tell you what happened (maybe) but if negative would not rule out the possibility. Further, there is no therapy for mono, you just need to wait it out.

Hepatitis. Hepatitis B can cause these sorts of symptoms even without jaundice.  In the U.S. it is quite rare however as most Americans are now vaccinated against hepatitis B- are you?  If not a blood test for hepatitis B in a month or so might be helpful in sorting this out although personally, I see little need for it (what would you do if you found that you had hepatitis B and got over it-- the answer is nothing)

Other "every day" community acquired viral infections. I suspect this is the most likely possibility.  There are thousands of different viruses that can cause these sorts of symptoms that people get every day.   Far too many to test for and, if all resolve, not something to worry about.

I hope these comments are helpful in terms of possibilities and general direction. If you are back to normal, other that the unlikely possibility of HIV which can be ruled out at this time, I personally see little reason for concern or testing unless your symptoms recur.  EWH