Your opinion doctor

Hello Dr. Handsfield, I hope you are well.
Here is my situation. About 3 weeks ago I had sexual encounter with CSW. Of course with my luck condom broke. Of course I freaked out. She was nice and assured me that she is OK and was tested negative for HIV 4 months ago, but I was still very nervous and tested her with Home Access HIV test next day - came back negative, so I felt better until 3 days later when I had genital herpes outbreak (I have history of HSV-2 and sometimes have outbreaks, but that happened just 3 days after sex with prostitute) - I talked to one of our ID doctors (I'm physician myself) and he said that this outbreak has nothing to do with possible HIV exposure, most likely stress related or irritation. So I calmed down, but was stupid enough to have oral sex with another CSW 5 days ago (she gave me oral only, no other sexual exposure), at that time my herpes lesions completely healed, but I became very nervous again despite the fact that it almost impossible to get HIV from receiving oral sex from female (am I right?). Anyway, now about 3 weeks after my first exposure and 5 days after second one I don't feel right. I have no fever or lymphadenopathy, but feel weak and tired for last 2 days and have some minor right sided throat discomfort. Of course I'm very nervous again, losing my sleep and thinking only about if she was in her window period and test did not show anything, or that I got HIV from oral sex, anyway please tell me what you think about my situation, what I should do and if my symptoms could be beginning of ARS.
Thank you so much

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

It seems you're suffering a disconnect between your intellectual knowledge of the low risks for HIV in this situation (first partner uninfected, low risk of oral transmission of HIV, reassurance by your doctor) and an emotional reaction that worries that exceptions to the rule, however rare, do occur -- and that you will be the rare exception that proves the rule.

Rest assured that the latter almost certainly won't happen.  Your symptoms really don't hint at HIV, which simply doesn't cause the vague sorts of feelings you describe.  And the onset (3 weeks) was too late.

From a strictly medical or risk assessment perspective, you don't even need HIV testing.  But it is clear that you need testing for its reassurance purposes; I doubt my words are going to completely settle your fears.  So get tested.  Just have a standard HIV antibody test about 4 weeks after the first sexual encounter; a negative result will be highly reassuring, since 90-95% of newly infected people have positive results by then.  For a final definitive result, you can have a second test at 6-8 weeks.  (Or just have a single test at that time.)

In the meantime, mellow out.  It is exceedingly unlikely either of your partners had HIV or that you became infected.

Regards--  HHH, MD

[mih75]

To Dr. Handsfield:
Thank you very much for prompt response.
As far as I know acute HIV can start any time between 2-4 weeks and symptoms could vary significantly from mild to pretty severe and malaise (looks like what I experiencing now) one of the most common symptoms.
What do you think about that herpes outbreak after my first exposure - could it put me at more risk from oral transmission even when lesions grossly healed?
And the last thing: what the chance that my first contact was in her window period or test just was read wrong?
Thank you again.

[H. Hunter Handsfield, M.D.]

Having genital HSV-2 roughly doubles the risk of HIV, if exposed.  Whether or not an outbreak is present makes no difference; just having the infection, with or without symptoms, is the only factor.  And first you have to be exposed.  And double a miniscule risk is still miniscule; e.g., a 1 in a million risk becomes 1 in 500,000.  Big deal.

Given the rarity of HIV in partners like you describe, the odds your partner was in the window period is too low to measure or worry about.

You're not going to be able to talk me out of my reassurance.  Please accept it at face value and move on.

[mih75]

To Dr. Handsfield:
Thank you, but you did not answer about acute HIV - did you personally see many cases of acute HIV? Is it possible to have it without high fever or lymphadenopathy but just with mild symptoms like malaise and sore throat? And also about onset of symptoms - you said that 3 weeks after exposure is too late (actually I started not feeling well 18 days after exposure), but I was reading that onset could be anytime between 2-4 weeks.
And finally - should I completely disregard that oral exposure week ago or count 4 weeks for test from that date?
Thank you again

[H. Hunter Handsfield, M.D.]

What does it matter how many cases of acute HIV I have seen personally?  The data are the data, regardless of my personal experience.

It is unusual to have ARS without substantial fever, but probably it happens sometimes.

You can disregard the oral exposure, especially since you're talking about exposure to a partner who has a low risk of having HIV.

That should end this thread.  I won't have any further comments or advice.  If you remain concerned, get professional care from a doctor or clinic and follow that advice.