a little freaked out

[alittlefreaked]

I had two encounters with escorts in Latin America in the last 5 weeks.  1st one I gave oral and then had protecetd sex.  2nd one was protected sex and then condom broke.  Probably inside for 1 miute before I realized. A bizarre aside is that some breast milk from the second one got into my mouth.  About two weeks after the first episode and 5 days after the second I woke up with malaise and the feeling of a low grade fever.  did not have a thermometer so didn't confirm.  I was extremely thirsty and drinking water like a racehorse at the same time.  I also had loose stools but no classic diarrhea although on the 5th day I did have one episode of diarrhea.  On the 5th day I also had a sore throat that then lasted about 5 more days.  In between I had constipation and bloating.  Whatever it was lasted two days.  On the 3rd day I had a temperature of 99 deg.  I am told by the doctor my glands are not swollen.  for 12 days (today being day 12 since the symproms I decribed) I have been moret ired than usual and wiped out by the end of teh day.  today (day 12) I developed an oral ulcer.  I have had these before, usually in connection with stomach issues.  in the meantime I also seem to have muscle and some mild joint pains although lessening now and the last few days.  Questions:

1) could an acute HIV fever symptom be as low as 99 deg?

2) do acute HIV symptoms all come at once or could there be a 12 day lag b/w 1st onset and a mouth ulcer?  5 day lag until diarrhea and sore throat?

3) what is earliest you recommend getting an HIV test?  It has only been 2 1/2 weeks since the second encounter.

4) I continue to be somewhat dehydrated.  Could this be a symptom of acute HIV.

5) does the breast milk issue (2nd escort) increase my risk?  If so, could the symptoms start as early as 5 days later?  

I did have a separate flu b/w the 1st and 2nd escort that two other colleagues of mine got.  Howver, no one else has developed the syptoms (symptoms) I described above and that is concerning to me and makes me think it is not a bug that is going around, etc.

Generally I am very concerned b/c I just don't feel right.  I was traveling a lot until about 1 1/2 weeks ago (through Latin America and Europe).

[H. Hunter Handsfield, M.D.]

Among persons traveling in Latin America who get malaise, diarrhea, dehydrations, etc, many, many more have garden-variety gastrointestinal infections than HIV--and your sexual encounters were very low risk.  The breast milk exposure doesn't mean much; many HIV-infected moms never infect their babies over 3-4 years of nursing.  See numerous other threads about the low risk for any single episode of acquisition of HIV through unprotected vaginal intercourse.  Your risk isn't zero, but it's probably in the order of 1 chance in 1000, even if the partner with whom the condom broke was HIV positive, which she probably wasn't.

You probably don't have fever; a temperure of 99 usually is normal.  Many people assume 98.6 is a rock-solid number and that it is the maximum normal temp.  In fact, it is just the average for the population; everybody's tempurature fluctuates during the day and we all at times have temps up to ~99.5 without signifying illness.  And some persons' average is as high as 99.0.

Lots of things cause oral ulcers, and HIV generally isn't one of them.  Maybe just a garden-variety canker sore?  Or conceivably sexually acquired herpes, although the 12 day delay to onset argues against it. Some viral infections can cause both diarrhea and oral ulcers.

Is it *possible* your symptoms are due to HIV?"  Yes.  Most infected people have positive result by 2-3 weeks, and it is virtually universal by 6 weeks; official recommendations say 3 months but it is rare for seroconversion to be delayed that long.  So go ahead and get tested now; the negative result will be reassuring, even though not definitive.  Get tested again at 6-8 weeks just to be sure; and also have a syphilis test at that time (it's too early now).  In the meantime, don't lose sleep over this.  But of course follow up with a health care provider if your symptoms persist, regardless of the result of HIV testing.

Good luck--  HHH, MD

[alittlefreaked]

clarification.  The original flu like illness I mentioned b/w the 1st and 2nd escort went away in all 3 persons (including me) prior to the symptoms I described.  They are not overlapping unless somehow the original virus/flu was reactivated because of my tough travel and meeting schedule.  Either way, the symptoms were different.  First flu had a lot of nsal congestion.  what I was describing above was very dry (no nasal congestion at all).  Malaise and "hot" feeling which may have beeen low grade fever went away by 3rd day.

[alittlefreaked]

also, forgot to metion I have had varying levels of shortness of breath for the 12 days since symptoms I described began and that my blood pressure has increased accoring to doctor I visited.  Usually 120-130 over 89-90.  Now at 140 over 100.  Note sure if these could be symptoms of acute HIV or perhaps anxiety.

[OldCoach]

I thought I would give this a try as I am desperate and do not have a credit card I can discreetly use.  I did send a $20 donation to MedHelp in Melbourne, so we will see.

I am a 54 year old elected judge in a small county in the South.  Six months ago I was receiving a massage and the lady asked me if I wanted something special and not knowing what she meant I said yes.  She then began to perform fellatio on me.  The whole process was less than 30 seconds until I realized what was going on.  As I had not been in this situation before I did not think of STDs until about 4 weeks later when I went to my Internist and told him what happened.  He asked if I had any symptoms and I said not that I know of -- he replied you would know if you did.  I said the only thing is I have been really nervous the last few days and have been urinating often and rubbing myself raw from checking (I put hydrocordison on it and it was fine). I also told him I had taken one or two 500 mg tablets of amoxycilin for a tooth infection.   He then said he would run a screen -- microscopic urinalysis and blood -- to see if there were any abnormalities before checking specifically for STDs and not to worry about the antibiotics as they would not have an impact.  The screen came back fine and coupled with the lack of symptoms he said don't worry.  With this I began to have a relationship with my wife.

I did not until I started reading on here that the screen was probably not optimal and I needed to have a full STD panel almost 5 MONTHS following the exposure.   I went to a larger city and had the screens run twice -- once with a swab and once using urine.  Both came out negative and the people at the clinic said if I had an STD during this period it would still be in my system. I have read on here that some of the STDs would have cleared on their own.

I am really confused and don't know what to do.  If I tell my wife or I passed her an STD earlier (she has begun to bleed a bit but she is in menopause and is going to the OB in 2 weeks) my marriage and career are probably over due to the scandal.

Dr., my questions are: 1) was the screen he did at 4 weeks close to reliable, 2) does the absence of symptoms help, and 3)would these things have cleared on their own during this time.  I know I am clean now, but can I be somewhat confident I was earleier as well.  Sorry to do this, but I am not doing well and need help.

[H. Hunter Handsfield, M.D.]

The reason for the credit card charge is independent of donation.  It is intended to limit the number of new threads to a manageable number of people with serious questions, which it has done successfully since instituted a couple of weeks ago.  As you will surely understand, that won't work if exceptions are made.  Some people who lack a private card (e.g., shared with a spouse) can prevail on a friend to use theirs.

In the meantime, there are lots of threads on this forum about the near-zero risk of STD acquistion by oral sex.  For practical purposes, your questions have been answered many times.

HHH, MD

[alittlefreaked]

what about question re: onset of symptoms for acute HIV?  Do they all come at once or can there be a 12 day lag between the malaise/fever and oral ulcer?

[OldCoach]

Dr.

Thanks.  I will find someone to lend me a credit card.  The donation is still there as I feel this forum helps educate people.  Also, I have read every thread on here regarding this subject and still have some concern as you may understand.  You are very helpful to people -- I wish I could have come to you at the beginning as it would have made my life more bearable as it has not been fun the past month.

[H. Hunter Handsfield, M.D.]

No need to pay $10.00 for a new thread for this question.  I deleted your new post and have asked the web administrator to refund your fee.  You asked "In acute HIV phase do the symptoms appear at once or over time. For example, could an oral ulcer related to the acute HIV phase develop 12 days after onset of first symptoms?"

I can't answer in detail.  My impression is that most symptoms probably develop over a week or so.  Oral ulcers are not a common symptom of acute HIV infection, but if they occurred I just can't say whether a 12-day interval is likely.  Sorry--

HHH, MD