Possible Exposure/Early HIV Symptoms

[2muchfun]

Hello Doctor,

Thanks for this forum, it is full of great information. I'll get right to it:

I had unprotected sex with a lady I work with and two weeks, exactly 14 days later, I came down with a severe fever. It appears the fever has broke now, which would have made it last for about 36 hours. It is the only symptom I have had which is really strange to me. Actually, I had the shakes and chills associated to high fever, but not the "triad" of symptoms I have read about in the blogs and forums in your website. I had no sore throat and no rash as far as I can tell. I went to the ER with the temp issue and the doctor said I probably had viral syndrome. She eluded to Enterovirus, but she didn't ask of any possible sexual exposure or anything like that. They took blood and my WBC was 11, not sure what that means. She said my blood work was normal which counted out anything bacterial from what she told me.

The lady I work with is not someone that would do drugs or anything like that, though I suspect she has a wild sexual side and I am not certain how promiscuous she is, which is a large part of my concern. I intend to chat with her when I find the opportunity, but wanted to seek your input for my most recent issue, which is the illness I am feeling and seem to be coming out of.

I guess my questions are:

1. Is a 36 hour fever typical for early HIV syndrome or does it last longer?
2. Is it likely to have only one symptom when having early HIV syndrome? With the fever I had chills and shakes, but like I said previously, not the "triad" of symptoms of high fever, sore throat, and rash. Just the fever and associated issues with it.
3. Lastly, what would my perceived risk be with a one time exposure to a female if she were HIV positive?

Thank you.

[H. Hunter Handsfield, M.D.]

There are no medical conditions that interfere with HIV test resliability, except possibly life threatening conditions like terminal cancer.  You need not wait at all before being tested.

[2muchfun]

Hi Doc,

She agreed to test. I have annual checkups as you recommend and it is time for me to get mine done anyway, so in addition to her getting checked, I am going to go ahead and do mine too. I will post results as I know you track those that are worried about HIV and their respective outcomes.

Another question about testing. If what I had was just a "flu" like illness, can this interfere with a ELISA test? If so, how long should I wait after having the illness to test?

Thank you doc.

[H. Hunter Handsfield, M.D.]

The HIV antibody tests generally are positive within 2 weeks (often 1 week) of onset of symptoms, so a negative result now would be reassuring but not quite definitive.  However, you need not wait 3 months for definitive results.  The stand-alone antibody tests are virtually 100% reliable at 6-8 weeks, and the combination antibody/p24 antigen ("4th generation") tests at 4 weeks.  See http://www.medhelp.org/posts/HIV-Prevention/-A-Question-on-Testing/show/1347755

However, you also could have a definitive answer if your partner is tested and negative.  You could then skip any testing yourself.  However, she might find it reassuring to know you are also HIV negative -- in which case the timing of your test won't matter.

[2muchfun]

Thanks Doc. That's both reassuring and good guidance. My logical follow up is this:

1. If I did have some sort of ARS, could I test soon with good confidence in the result?

2. I intend to test at 3 months if I test now with a negative result.

3. Is this a good plan for testing?

Thank you.

[2muchfun]

I need to update my status, my fever returned, but I still have the same questions.

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Almost certainly your current illness is not HIV, and probably just a coincidence with your new sexual encounter.  Just consider the odds:  in the US, many people (tens of thousands, maybe) have new illnesses with ever every week; and every week there must also be tens of thousands of new sexual encounters.  Obviously, both things are going to happen to a lot of people, simply by random chance.  That random chance is far higher than the chance of catching HIV from an exposure like yours, which probably is in the 1 in a million range.  However, I cannot say it's truly zero -- especially if you are correct about your co-worker's possible "wild sexual side".

You should follow through on your plan to discuss your illness with your co-worker/partner.  Your concerns about HIV are not totally irrational, and she probably would understand if you asked her to have an HIV test.  If negative, will confirm you couldn't have caught HIV from her.  And if you were incubating your current infection -- whatever it is -- when you had sex, she could be at risk of catching it from you.  So there is a potential 2-way street here.

To your specific questions:

1) Fever in ARS typically lasts 1-2 weeks.

2) No, it is not common to have only a single ARS symptom.  If there are symptoms at all, usually all 3 of the triad you apparently know about are present:  fever, sore throat, and rash.

3) The odds of HIV transmission, female to male from a single episode of unprotected sex -- if the woman has HIV -- has been calculated at 1 in 2,000.  That's equivalent to having unprotected sex with infected women once daily for 5 years before infection might be statistically expected.  Of course transmission can occur from a single event, but it's rare.  The vast majority of heterosexually infected persons are the regular partners of infected persons.

My final comment is that you apparently let your doctor ask the questions when your fever was evaluated.  In today's world, most docs would ask about sexual exposures.  But it is equally the patient's responsibility to offer potentially pertinent information.  If your sexual exposure was on your mind, you should have said something.  Don't get me wrong; I don't believe there is any realistic chance you have HIV.  But if your fever continues, you definitely should return to the doctor (or your own primary physician) to sort it all out.

Regards--  HHH, MD