Symptoms of ARS?

[porfiry]

Hi Dr.,

I had sex with a CSW in Hong Kong 18 days ago. It was protected vaginal sex. I have HSV-1 genital herpes, so I was very careful not to let my penis touch her before she put on the condom. We kissed and I inserted 2 fingers into her vagina, and she was lubricated. She removed the condom herself, and I think nothing went wrong there.

A week later, a blister appeared on one of the fingers, and I began getting hot flashes. At day 10, I noticed that my tongue was white and furry at times. Day 14 - started night sweats, now 5 nights in a row. I'm taking sleep medication but not sleeping well. Day 16 - rashes on inside of thigh and elsewhere (although I often get fungal rashes.) Yesterday my appetite decreased; I only want sweets and I drink a lot of water. I think I've lost a few pounds. Today, Day 18, a mild fever.

Do I have cause for concern for HIV, or is this purely stress?

Thanks,
Concerned

[H. Hunter Handsfield, M.D.]

Glad to hear about the initial negative HIVantibody test.  I'm not sure why you are planning to not trust the results of the antigen test.  Most likely it will be negative, providing further evidence against HIV.  Symptoms never give good clues for or against HIV, because the symptoms of HIV are identical to those of many other, mostly minor health problems.  It is very unlikely you have HIV.  But continue to follow your doctor's advice about follow-up and further tests.

[H. Hunter Handsfield, M.D.]

I already told you that your negative PCR result is strong evidence you weren't infected.  16 vs 14 days makes no difference.

Your doctor seems not to understand that 6 weeks is almost always sufficien time for the HIV antibody tests to become positivet.  Even if your doctor feels a need for a 12 week test, there is no reason not to test earlier as well.  But whenver you are tested next, the totality of evidence -- the nature of the exposure, the PCR test result -- makes it almost impossible you have HIV.

Whenever you are tested again, I will hbe happy to comment at that time. But until then I will have no more comments of any kind.  In the meantime, try to mellow out.  You don't have HIV.  If I were a betting man and in Las Vegas, I would be comfortable betting my house and all I own on it.

[H. Hunter Handsfield, M.D.]

I know you are concerned, but there isn't anything I can do right now.  It is pointless to speculate; your test results will tell the story.  I continue to believe you don't have HIV.  And by the way, true nightsweats occur because a fever breaks during the night, and they typically soak the bedsheets, to the point they often need to be changed.  A little dampness, in someone who is anxious and awake, usually isn't a true night sweat.  And don't forget the other part of my reply:  you had an exposure that was exceedingly unlikely to result in HIV transmisison.

Speak with your own doctor about your nervousness and sleeplessness.  But let's hold off on further comments here until your results are available.  

[H. Hunter Handsfield, M.D.]

Welcome.  Yes, wrong forum -- but I'll have it moved to the HIV forum.

Several factors add up to essentially no risk for HIV:  Most CSWs aren't infected, including those in Hong Kong; even without a condom, the averag female to male transmission risk for each epsiode of unprotected vaginal sex is around 1 in 2,000, and that's if the woman is infected; and you used a condom, which is highly effective in preventing HIV.

Symptoms are poor indicators of new HIV infections.  True night sweats indicate fever, and could go along with HIV -- but also with just about any other garden variety infection.  But if you have taken your temperature and it isn't really elevated (38C/100F or higher), that's strong evidence against HIV.  Coated tongue goes along with almost any minor infection.  I don't know what to make of the "blister" on your finger.

All things considered, I don't have any real concern you caught HIV.  However, most people who are worried about HIV should be tested.  Even if the risk is very low, as it is here, most people nervous enough to come to this forum probably need to be tested for reassurance.  It would make sense for you to see a health care provider about your symptoms then follow his or her advice about diagnostic testing.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Of course no surprise your test was negative.  So will any other tests you do; there is no need to post any more results.  That will close this thread.  Take care and stay safe.

I do not expect CDC to change its recommention about antibody testing at 3 months.  The following thread explains why:

http://www.medhelp.org/posts/show/1347755  ;

Also, all the discussion about window period is pertinent only to the stand-alone antibody tests.  With the proliferation of readily available tests for p24 antigen (usually combined with antibody in the duo test) and HIV PCR, anybody with a high risk exposure can have definitive test results 4 weeks after exposure.

This isn't intended to open an ongoing discussion about it.  This thread is closed to new comments.

[Valdez11]

Forgive me doctor Hansfield but I have one question. In your opiniion, 6-8 week test is sufficient in a low/medium risk situation. I read this forum very carefully and I am one of your biggest fans. I know that you always work with probability of infection in a first place.

Low probability of transmission+negative test result at 8 weeks=NO HIV

Is this equation right in my understanding?

HIV window period is one of the biggest phenomenon in a medical science I think.

Some countries, for example France has 6 weeks window period /testing with DUO/
In my country, Czech republic /also in Israel/ there is 2 moths window period, if person has no immuno disease.

And in a most of countries there is 3 months mark conclusive.

We know that the average time when the antibodies are present is time frame between 22-25 days. Why they come up with 3 moths? In my opinion 6 or 8 weeks is plenty.

I took a test after low risk exposure at 8 weeks /DUO test/ , then I red your testing recommendations in a simillar cases and I have decide to move one without additional testing, because I think the real window period is shorter than 3 months.

Do you think that maybe one day in a near future the CDC will change official testing guidelines from 3-6 months to 8-12 weeks?

[porfiry]

Hi Doctor Handsfield,

I went to the local AIDS Services Foundation this evening, where the counselor, who was sympathetic and pretty humorous, assessed my risk of HIV as essentially zero. I agreed, but explained that I had (probably irrational) concerns because of the timing of my perceived ARS symptoms. He agreed to test me using the Ora-Quick test. I am HIV negative at 7-1/2 weeks post exposure!

He agreed to re-test at 13 weeks post exposure, so I'll post my results at that time.

I'm sorry to have pushed the limit on asking about the PCR RNA test. I had at first erroneously stated that it was an HIV Ag test, and I thought your comments might have pertained only to that test and wanted to clarify. I think some of the other posters will find your comments about that test helpful.

Thanks again for your advice, patience, and your Vegas scenario.

Best regards.

[porfiry]

Hi Dr. Handsfield,

Well, I tried to test again at 6 weeks, but my doctor told me that county officials contacted him after we did the last test asking questions, evidently concerned about this potential risk! That sounds strange, since many people are screened on a regular basis. He wants me to wait until at least 12 weeks.

I'd like to know your opinion about my negative PCR RNA test at day16. I've read so many conflicting opinions about that testing method that I'm not confident in its results any longer. I may go to a private STD clinic for a 6-week Rapid test.

I know I had a low-risk encounter, but the irrational in me would like a resolution. I value your knowledge and thoughts about this.

Thanks again.

[porfiry]

Dr., I got my results back:

Correction: Test was PCR RNA on Day 16, not Day 14. Negative.

I'll test for antibodies at 6 weeks, 12 weeks and 6 months and keep the forum posted.

(I should feel at least some relief from the PCR results, but I just feel really tired.)

[porfiry]

Thanks Dr. Handsfield.

[porfiry]

Hi Doctor,

I just woke up with night sweats for the seventh night in a row, and remembered something that may change the diagnosis.

As I said earler, I have genital Herpes HSV-1 and had a recently healed wound at the time I had sex. After she removed the condom, I was still erect and began massaging my penis. Considering that I had her veginal fluids on my fingers from a few minutes before, could HIV have been transmitted in this way?

Thanks. Very nervous and can't sleep.

[porfiry]

Thank you for your continued patience. The fever seems to have subsided. But the white tongue really bothers me, although I may have had this condition before and am only now hyper-sensitive to it since I've been reading about HIV ARS symptoms non-stop for days now.

I'll keep the forum updated on my results.

Best regards

[porfiry]

Dr. Handsfield, I don't know if this format allows me a secondary question or comment. Fever is now up to 99.5F, and I'm usually at 97.5F. Eyes are glazy and cheeks are on fire. Does this change the diagnosis?

Thanks

(I'll leave you alone now.)

[porfiry]

Thank you doctor. I did got to a clinic at the 14 day mark. I was tested for HIV antibodies (because I had not been tested for a while) and I also asked for a HIV Ag test.

The antibody test was negative (same day results) - at least I haven't been infecting anyone else.The results of the Ag test won't be available until next week, but I'm not sure if I will trust the results of that.

Again, thanks for the quick response.

[porfiry]

I think I posted my HIV question in the wrong forum. My apologies, but I thought I clicked on the correct link.