Sinus/sore throat

[lafort550]

Dear doctors

My story is, that I had sex with a CSW from Thailand (working in Denmark in a Thai Massage clinic) 4 months ago, and the condom broke. I noticed a small sore/cut just below the penis head afterwards.

I asked her if she had any deseases, and replied that she did not, and that she had been tested 3 months ago

17 days after exposure, I developed a mild "on/off" sore throat in the left side of the throat. No fewer, rash, myalgia etc - but problably due to the anxiety I did develop fatigue, headache and some night sweats

After a month of this "on/off" sore throat I went to the doctor, who could find nothing wrong with the throat, but noted slightly swollen nodes under my chin. I also went to an ENT specialist, who did an endoscopi, and also could not find anything wrong.

As of today (4 months after exposurem, and 3,5 month after the initial sore throat), I still have an "on/off" sore throat. As I am also somewhat congested in the back of the left side of the nose, I am guessing that the "on/off" sore throat is due to post nasal drip from a one-sided sinus infection (I often get sinus infections, but never before with post nasal drip).

I know that the chances for catching HIV from a single exposure is small. And I also know that my symptoms are not typical of ARS, with the absence of fewer, rash and a "severe" sore throat. And I also know that symptoms are not supposed to last much more than 2 weeks

But the reason for posing on this forum is, that I still cannot completely get it out of my head, that it might somehow indirectly be connected to HIV.

1) Is the body less resistant toward developing infections unrelated to hiv during ARS?

2) If so, can a sinus/post nasal drip sore throat be a sign of ARS?

3) If so, could the sinus/post nasal drip sore throat be the only ARS symptom, or would there also be other more classical symptoms such as fewer, rash etc?

4) Could there be any way ARS symptoms would last for almost 4 months (and counting)?

[Edward W Hook, MD]

There is no place on earth that you cannot easily get tested for HIV.  you should since it is clear that you worry that every minor illness, rash, etc that you have could be a manifestation of HIV that you are at little risk for.

In answer you your specifc questions:
1.  No, not likely.
2.  No
3. No.

This thread needs to end.  you need to get tested so you can put your fears to rest.  EWH

[lafort550]

I have not been able to get a test yet, and will not be able to for the next month either.

It has been 5 and half month since my incidence with a broken condom. In the last 14 days, I have developed a very mild but itchy rash on the upper side of my chest (only on the left side, so SD is out of the question, and not papular either), and an irritation of the skin of the scrotum (but no rash).

I have also developed Tinea Pedis, which I have never had before in my life (I was in a public swimming pool area 3 weeks ago though).

On diferent sites I have seen that both skin disorders and fungal infections are listed as poosible early markers of HIV, but:

1) Would it be possible/likely that the skin rash is due to HIV after only 5,5 months?

2) Would it possible/likely that the Tinea pedis is due to HIV after only 5,5 months?

3) Is it true, that rapid progression towards AIDS is more likely in persons who have experienced severe ars?

[Edward W Hook, MD]

These are "what if" questions that really have little value but they do suggest that you continue to worry about this exposure.  If you are worried (and it appears that you are), you should get tested and then believe the test results.  I am confident your tests will be negative.  EWH

[lafort550]

You actually work wonders, as my sore throat has disappeared after your answer, and I have had two wonderfull days with peace of mind.

But today I am beginning to develop a cold sore on my lip. I havent had these for years, and recall reading that this is a prominent feature in advanced HIV with lov CD4 counts.

Is it anyway possible, that a herpes simplex outbreak 4 months after possible HIV eksposure is in anyway related to HIV, due to lowered immune response, as a sign of rapid progression towards AIDS? If not, when is the earliest you could/would expect a HIV related herpes simplex outbreak after getting HIV.

I am sorry to ask this question, but I have searched this forum without being able to find anything related to this, and I rate your opinion very high. If I am supposed to ask this question in a new thread, and pay a new fee, please let me know  

[Edward W Hook, MD]

Yes, you have summarized my response correctly.  Take care.  EWH

[lafort550]

Thank you very much - your comments are most helpful

I know it was a virtually no risk exposure I had, and had it not been for my problaly sinus related problems, I would not worry.

But to sum it up you are saying that:

1) Sinus infections/post nasal drip are not considered ARS related, not even indirectly as an opportunistic infection?

2) A sore throat (from sinus/post nasal infection or not) would not appear as the only symptom of ARS?

3) Opportunistic infection related to ARS, and ARS symptoms in general, do not last for more than 2 weeks, let alone 4 months, so even if my symptoms could be considered a possible ARS symptoms, the length of the symptoms would most effectively rule that possiblity out?

If all of the above statements are correct, I will be able to find peace, and will also rest assured that the mere fact that I have posted in this forum will grant me security -  as proven by your 8 year long track record of no persons posting on this board turning out to be HIV positive.

Best regards

[Edward W Hook, MD]

Welcome to our forum. I will try to help.  It is clear from your post that you have already researched matters related to HIV transmission and the ARS and are well informed on the topic so I will not go into detail on  the basics, it appears you fully understand them.  Your questions suggest that you are taking some of the information available about HIV and the ARS out of context and it is worrying you.  

I also note that you do not mention HIV testing.  HIV tests are superb and if you have concerns, you should have a test (once) and commit to believing the test results.  At this time an HIV test result will provide definitive information on you HIV status.

Finally, I will just verify your comment that there is low risk of HIV from your exposure and that the symptoms you describe are not characteristic of the ARS.  We these statements, let's now address your specific questions:

1) Is the body less resistant toward developing infections unrelated to hiv during ARS?
The ARS occurs as persons begin to fight HIV with the production of antibodies and cellular immunity.  During the ARS a person’s T-cells fall dramatically and there are a handful of cases in which persons with ARS have had thrush or even opportunistic infections which are more typical of HIV infections that have been present for years.  This weakened ability to fight infections is quite uncommon however and in those who experience i, it occurs for only a week or two.  

2) If so, can a sinus/post nasal drip sore throat be a sign of ARS?
No.  The ARS is typically a flu-like illness. While sore throat can be part of it, sinus symptoms are not typically prominent.

3) If so, could the sinus/post nasal drip sore throat be the only ARS symptom, or would there also be other more classical symptoms such as fewer, rash etc?
Again, this is not consistent with the description of the ARS.

4) Could there be any way ARS symptoms would last for almost 4 months (and counting)?
No.

I hope my comments are helpful.  If you are still having trouble accepting that you did not get HIV from the virtually no risk exposure you have described, and have not tested, you should test and plan to believe the result. If you have tested and still do not believe the result, I suggest you work with a counselor to get assistance in working through these unwarranted fears.  I hope my comments are helpful.  EWH