Sore Throat After Exposure

[blue737]

Hi Doctors,

Thanks for taking my question.  I am concerned about a really bad sore throat that I've been having.  Her's my situation:  On March 14th I had a lap dance with a latin stripper.  She put a condom on my penis but didn't roll it on (she kind of spread the opening and pushed it over my penis). She then gave me oral sex for a little bit.  Then, she sat on top of me and I had vaginal intercourse with her using the same condom (5 minutes approx).  My penis was limp most of the time, so I think that because of this, the condom may not have covered my entire penis while inside her. When she withdrew my penis because I couldn't keep an erection, the condom was baggy at the top and covering only a little more than the head of my penis. It don't believe it broke.  There was also some fingering and french kissing.

On March 19, I began taking 875mg of amoxicillin w clavuanate pot for something else. I finished taking this on March 29th.  On April 1 (3 days after finishing medicine and 18 days after the sexual encounter), I came down with a bad sore throat.  It is terrible when I swallow, and I still have it today. My temp is about 97.5 - 98.5. A couple of times it went to 99.4.  When I swallow, it hurts in the throat, above and to the left and right of my adams apple, and sometime to my ears.  No cold symptoms or stuffy nose, etc. Went back to doc, he gave me pack but urged me not to take it because i just cam off meds. he said no swollen glands in neck but red throat.

1. Does this sound like ars (bad sore throat for 5 days, fever, but no other symptoms?

2. My normal temp is about 97; therefore, is 98-99 a potential ars fever in my case?

3. Is it a concern that the my penis was limp and the condom was baggy and not covering my whole penis when she withdrew my penis?

3. should i get tested for hiv now?

Thanks so much.

[Edward W Hook, MD]

I would assess your risk of having HIV form the activites you have described at being substantially less than 1 in 1000.

Now it is time for this thread to end.  Take care. EWH

[blue737]

Thanks for such quick responses, Dr. Hook. I don't see anything unusual or any white patches in my mouth, but I will follow up with my doctor.  I promise not to continue posting more questions, but if I can just ask one more I'd appreciate your thoughts on the following:  

I think I'll wait for a 6 week test and was just wondering if, in the meantime, you could tell me what you think my risk or probability of HIV is relating to this exposure.  Would it be something like 1 in 100 or 1 in 1000?  

Thanks very much, Dr. Hook.

[Edward W Hook, MD]

thanks for the clarification.  This could still be thrush, as a conseqwuence of your antibiotics. the antibiotics make thrush more likely.

Regarding testing, if you want an answer today, you need a PCR.  On the other hand, if you feel comfortable waiting (and there's no reason not to feel comfortable waiting) a six week finger stick test would certainly tell you if your current symptoms are due to HIV.  EWH

[blue737]

Thank you for your response, Dr. Hook.  I'm sorry for not elaborating as to why I was prescribed the amoxicillin. I was taking it for a small skin infection on my leg and not for thrush. When I returned to the doctor a couple days ago about my sore throat, he said it wasn't strep but could have been a virus or bacteria of some sort. He gave me z-pack but said not to take it unless it doesn't go away on its own, since he didn't want me to take antibiotics again.

I'm not sure if this changes your assessment?  Also, just so I'm clear on answer 4 above- if I were to get tested with a standard finger prick rapid test 6 weeks from my exposure, would it be accurate or because of the symptoms would I always need the PCR test?

Thanks

[Edward W Hook, MD]

Welcome to the Forum. I'll answer your question but first a few comments.  In general, most commercial sex workers do not have STDs and most STDs do not lead to transmission of infection. Thus, even if the condom failed, there is little risk of infection.  Second, if the condom did not break and stayed on, covering the head of your penis, this was a safe exposure and there is little chance of HIV.  Genital contact, or contact of genital secretions with skin, including penile skin, virtually never leads to transmission of HIV,   Third, given your recent antibiotics, I wonder if you do not have thrush, the oral and esophageal infection often precipitated by antibiotics and which can present as you describe and can cause precisely the symptoms you are describing.

From your description, I would  not be worried about HIV but would worry that either you have thrush or, as an unrelated event you have had the misfortune to get a community acquired viral sore throat.  

With this as background, let's address your questions:

1. Does this sound like ars (bad sore throat for 5 days, fever, but no other symptoms?
These symptoms are some of the descriptions which are described for the ARS.  So are diarrhea, muscle and joint aches, and a skin rash.  When persons with all of these sorts of symptoms are evaluated in scientific studies  however, less than 1% turn out to have HIV. Thus, this is not classical ARS (you are missing some of the symptoms) and even if it were, it would be rather unlikely to be HIV, both on the basis of the nature of your exposure and the fact that you used a condom.

2. My normal temp is about 97; therefore, is 98-99 a potential ars fever in my case?
No, the typical fever of ARS is substantially higher.


3. Is it a concern that the my penis was limp and the condom was baggy and not covering my whole penis when she withdrew my penis?
Probably not.

4.  should i get tested for hiv now?
That, of course, is up to you. the chance that his is HIV is VERY low.  If this is the ARS, the proper test to have is a PCR type test for viral RNA, not a regular blood test. Typically, the standard blood tests for HIV become positive about a week after the beginning of ARS symptoms.

If I were you, I would not seek testing but if you are nervous, you could get a PCR.  should you choose to do so, I am confident your test will be negative.

I hope these comments are helpful.  I would have a doctor take a look at your throat to make sure you don't have thrush.  EWH