Feeling Anxious risk and symptoms

[sean1498]

Hi Doctor Cummings,

I need some advice please - Dr Google has me very worried. I am seeing a guy who is HIV+, after several weeks I finally felt comfortable enough to have sex with him for the first time (I'm a guy too). I should add that my partner is on HAART and is currently undetectable viral load.

We had protected anal sex (I was bottom) and unprotected oral sex - I havent had anal sex before so it was quite painful, we changed the condoms a couple of times but the sex was a bit rough, too rough for me and ended up bleeding a little later that day. As far as I and my partner are aware, the condoms didnt break - but I'm worried as we didnt subject them to any tests afterwards - he said it would be unlikly that he wouldnt have noticed and visual inspection didnt reveal any faults. My partner didnt ejaculate either in my mouth or in my bum. My partner is quite large so the oral sex was tough and I gagged a little.

I started panicking almost immediately afterwards and started a course of PEP the next morning less than 24 hours after the event. About 3 or 4 days after the event I got a sore throat lasting 4 days or so accompanied by swollen glands in my neck and a stiff neck and some sore joints- my throat looked red and whilst it was sore i wasnt unable to swallow or eat and I wasnt wincing in pain or anything, the next stiffness only lasted a day or two and the glands when back to normal after two days. Despite being on PEP I'm terrified that this is ARS.

I've read that ARS usually occurs 2-6 weeks after exposure but I also read on another site that it can happen in as little as 3-5 days because everyone is different.

Do you think these symptoms are ARS?

Can you get ARS while on PEP?

Does PEP fail often? I'm very strict with it and havent missed a dose and dont intend to - I'm beside myself with worry. My partner says he understands why I'm worried but that I have no risk.

Can you help please...what is your view? Am I a likley HIV+?

Thanks

Sean

[sean1498]

Hi doctor,

I thought I would re-post my follow question in case it got lost in the pile, I hope you don't think I'm being rude or impatient.

I found your initial answer very reassuring, I was just wondering if you could give me your opinion on two more points.

1). If I had been exposed to HIV would my symptoms of sore throat, swollen neck glands and stiff neck be suggestive of ARS?

2). If I had been exposed to HIV would I experience symptoms of ars at 4/5 days after exposure.

Some websites say symptoms can start as soon as 5 days after exposure, which i thought may be incorrect but i cant say that as im not a doctor and this is what concerns me if there had been an unnoticed condom failure. Like I said I didn't manage to give the condoms anything more than a visual inspection. I feel like a nutcase thinking like this so I apologise for taking up more of your time.

Many thanks

Sean

[sean1498]

Sorry, forgot to add, the pep regime I am on - truvada and kaletra is a different regime to my partner who is on atripla- would this affect it working?

Thanks again and take care

S

[sean1498]

Hi doctor,

Thank you fir your advice - this has helped calm me down. From what you have said I'm guessing that;

Chances of condom breakage + undetectable viral load in partner + no ejaculation or precum+ pep = very little chance of infection?

My last and final question, if you could be so kind (and patient) is - if there was a condom breakage would my risk still be low and despite what other websites say is it possible to have ars symptoms at 4/5 days after exposure if there was a risk?

Guess I'm just worried because of the sore throat + glands + stiff neck but I'm guessing 4/5 days would be too early anyway?

You guys do a great job. I'll bother you no more after these questions.

Thanks again

Sean

[Dr Sean Cummings]

Hi Sean

You can relax.

Your partners assessment is very sensible and I believe correct.

The condom was intact throughout and he did not ejaculate into the condom whilst inside you. He is on antiretrovirals and his HIV is well controlled with an undetectable viral load. The evidence available - which is good and increasing - supports his statements that there is no risk in the circumstance you have described.

You can get more information by reading this article by Hunter Handsfield and Edward Hook http://www.medhelp.org/aids-hiv/articles/Anti-HIV-Treatment-Markedly-Reduces-Sexual-Transmission/195

I do not think you have ARS and PEP is designed to suppress viral replication and so will halt ARS for the duration of treatment. Occasionally we use antiretrovirals to suppress ARS symptoms where people are very unwell ad they work well.

PEP can fail - but in your case you have a partner who is careful; well controlled disease and condom protected sex. You had a sexual event with an HIV positive person but you did not have an exposure.

If you had attended our clinic then we would have done our best to disuade you from taking PEP as it is not necessary.

You are fine. Truly.

best wishes, Sean