Risk Evaluation

[scaredhiv]

I have posted this in the regular forum before but wanted to see what the experts thought.

I am a 24 year old gay bottom. This summer I had a few casual sexual encounters with different men. These encounters began in June and by the middle of August I had wised up. All of the encounters were protected anally and unprotected oral (only one instance of ejaculation in the mouth.) Around 5-6 weeks after the last encounter I began to develop a few ARS like symptoms including swollen occipital nodes on both sides, posterior cervical nodes on both sides (both no bigger than a cm), and swollen nodes under the jaw. I also experienced 3 or 4 bouts of diarrhea before I noticed any swollen nodes and night sweats (although this may simply have been the fact that I have no air conditioning.) Not until I noticed the swollen nodes did I even think about the possibility of HIV. There was never any fever or rash. To say that my anxiety is out of control is an understatement. I went to the doctors about 2 weeks after I noticed the nodes and she put me on an antibiotic for what she thought might be a middle ear infection (although she wasn't positive that was the problem.) About a week before I woke up unable to hear out of my left ear because of major wax buildup. She also told me to take claritin as it could just be allergies. I had hoped the ear infection and possibly an upper respiratory infection would be the case. Now almost 3 months later I still have several swollen nodes in my neck (although they have decreased in size- all are under 1 cm), post nasal drip, and geographic tongue. I wake up almost every morning with some serious post nasal drip and a slightly sore throat, that quickly goes away once I am up and have eaten.
As you know the opinions on the risks from oral sex vary widely. Do you think from my exposure I should be concerned? Do my symptoms sound like another possible STD?

[scaredhiv]

Thank you Doctor.

[H. Hunter Handsfield, M.D.]

First, ARS doesn't cause most of the symptoms you describe (like nasal congestion, postnasal drip, small nodes in the neck only, symptoms of an ear infection).  Geographic tongue has a hundred causes, almost all more common than HIV.  Absence of fever is itself strong evidence against ARS.

Equally important, despite your concerns about your own behavior, it sounds like you had pretty consistent safe sex, especially since the anal sex apparently was always condom-protected.  As you learned on the community forum, from Teak and others, oral sex is low risk, despite what you seem to believe.  It is wrong that opinions on that "vary widely"  In fact, they very quite narrowly -- from those who believe there is no risk to speak of and those who believe there is some risk but that it is very low.  Nobody argues that oral sex in either direction is a high risk activity; indeed, most experts specifically include unprotected oral sex as a safe sex activity.

Do I think you should be concerned?  From a medical or risk assessment perspetive, definitely not.  But that's beside the point.  The fact is that you ARE concerned.  So have an HIV test.  Enough time has gone by for completely reliable results.  Given all you describe, you can be sure it will be negative.

Finally, good for you for wising up.  Obviously, having multiple casual sex partners isn't a good idea.  That said, you are using condoms consistently for anal sex, which is excellent.  The other thing you need to do, should have any relapses and resume such behaviors as last summer, is "do ask, do tell":  always ask partners about HIV status and share your own, before having sex, even when safe sex is planned.  (Condoms can break, and sometimes condom use is forgotten at the height of arousal.)

Stay safe--  HHH, MD