Possible ARS Symptoms

[veryafraid123]

Hello,

I am a man and I have been seeing a woman for the past seven weeks (I met her while traveling).  After two weeks, we began to have a sexual relationship.  Vaginal sex has always been protected with a condom, but we had episodes of unprotected oral sex.  I would estimate about 10 encounters of protected vaginal sex, about 8 encounters of her performing oral sex on me, and about 4 episodes of me performing oral sex on her.  Again, the oral sex was unprotected.  Our last encounter for all of the above was 13 days ago.

We haven't seen each other in about 2 weeks since we live in different parts of the country, but we've maintained contact with each other and want to continue the relationship.  About 8 days ago, I started experiencing some symptoms which include fatigue, swollen tonsils with pus, lack of appetite, body aches, itchiness, and an undetectable rash on my upper lips (i.e., the bumps are so small that they cannot be seen casually, but I can feel them when rubbing my lips together).  I went to urgent care to be tested for strep and it returned negative.  I've also had Epstein-Barr mono in the past.  I'm worried that these symptoms could be something more serious.

I asked her if she had a clean STD history, and she told me that she had not had sex since her last HIV test, which she said was negative.  My last encounter prior to this relationship was late last year in 2011, and I was tested back in late-April with a negative result.  When I asked her again she was offended about me questioning her first response and said that she would get an HIV test and send me the results.  She should have there results sometime this week (Tuesday or Wednesday).

Based on what this, do you think it is possible that this is related to ARS?  Given there is distance between us, I'm not sure how to take the validity of any results she gets, and I would just prefer to know my own status.  But I cannot take an HIV DUO exam until the four week mark and I'm really stressed.

[veryafraid123]

I just want to add that I am concerned about the oral sex because when we were having protected vaginal sex once.  After about fifteen minutes, I asked for oral sex and I took the condom off, but did not wash my genital area.  She then performed unprotected oral sex, and I'm worried that vaginal secretions from her were still on me when she started the oral sex.  She could have gotten some of the vaginal secretions in her mouth and I could have been exposed through the tip of my penis once she performed oral sex.  What are the chances of transmission this way?

[Edward W Hook, MD]

Welcome to the Forum.  The exposures you describe are not associated with meaningful risk for HIV.  I would not worry.  

Your partner has already told you she is HIV negative, base on testing.  I don't  blame her for being irritated at your repeated questioning and suspect that it (her report of not exposures since last testing) is more than you can say.  You should believe her. Further, in the very unlikely situation that she did have HIV, the infection is transmitted not more than once in every 10,000 acts of oral sex and that estimate is probably overly conservative.  

The symptoms you describe, like most community acquired viral illnesses, have some characteristics of ARS but not most of them and are more than a hundred times more likely to be due to a common, community acquired, non-sexually transmitted viral infection than to be from HIV.

Finally, the scenario you describe of her getting her vaginal secretions into her mouth and then being transferred to you by oral sex to cause acute HIV is not plausible for a number of biological reasons too complex to go into here.

My advice, do not worry. These were essentially no risk exposures.  I hope you find my comments helpful.  EWH