HIV Risk Assessment/ARS Symptoms

[WolfpupNX]

Dear Doctor,

I'm a 34 year old sexually active gay male.  I test regularly for HIV and currently test as negative (via Oraquick).

About a week ago, I had a multiple sexual encounters with another male (who also tests and assures me he's negative).  The main risks involved, if any, would be giving oral sex to completion multiple times, including swallowing, a little rimming, as well as unintentionally getting some of his semen into my eye.  From my understanding, while these are of course not no-risk activities, they are still relatively low risk activities (with some even possibly being theoretical).  I of course plan to continue regularly testing to assure my negative status.

That said, what concerns me is 4 days after (the first) encounter, I developed a sore throat (branching to my ear), fever (reaching 103.4 at its highest), general achiness, and alternating periods of chills and soaking sweats.  The fever lasted 3 days or so, and this is the 5th day and I'm feeling quite a bit better, though not 100%.  There was no vomiting (weirdly appetite stayed intact), diarrhea, or skin rash that I could see.

1.)  Would this be consistent with ARS?  My main worry is I don't know anything else with these symptoms currently going around, but I was traveling.  I know I've read ARS onset usually happens between 2-4 weeks, so this seems a little soon for ARS, and I've also read it lasts 1-2 weeks generally, so this seems shorter duration as well.  In addition, a few sites list the fever with ARS as being mild (102 or so), and mine was higher than that.  So I'm wondering if any of this rules out ARS?

2.)  Sometimes when I eat citrus, my tongue tip is sore.  There is no bleeding and no sore I can see...it's just a feeling.  Does this make oral sex any riskier?  I did have a bit of this looking back, but it's a fairly common occurrence with me and not related to poor oral hygiene (there's never any blood or "open sore" aspect that I can see).

Thanks Doctor!

[Edward W Hook, MD]

Welcome to our Forum.  Unfortunately, you have posted on the wrong site.   Questions about HIV belong on the HIV prevention site.  I will do my best to answer your questions with this reply but, if you have additional questions or follow-up they must be on the HIV Prevention site.  Sorry.

Congratulations on your commitment to safe sex.  it sounds as though your risk for HIV is low and there is no appreciable risk for HIV from the activities that you describe.  There is no known risk for HIV from receipt of oral sex and the risk for infection from performing oral sex on an infected partner is less than 1 infection in 10,000 exposures.  Whether or not dental disease, gum disease, or mouth sores increase that risk is unknown but it seems unlikely to be the case.

At the same time, the recent illness, while occurring earlier than would be expected does have many of the characteristics of the ARS.  As I suspect you know, the ARS is typically a severe flu-like illness.  The hallmarks of this syndrome are high fever, sore throat, muscle and/or joint aches and in some persons a rash or diarrhea.  The ARS most often occurs 2-4 weeks after exposure and typically when it occurs tests for HIV antibodies are positive just a few days after the illness begins.  The characteristics of the ARS are the same as the characteristics of the flu and other viral illnesses which occur both sporadically and as outbreaks in communities.    Your recent travel places you at somewhat increased risk for flu-like illnesses.

That citrus products sometimes are irritative to your tongue is unlikely to be associated with increased risk for HIV.

I hope my comments are helpful and again, congratulations on your commitment to safe sex.  EWH

[WolfpupNX]

Thanks much for the reply!  I apologize for not posting in the HIV-specific forum; I was hoping the general STD forum would suffice (I'm a bit more familiar with the docs here was the reasoning); I will remember to post there if I have any future questions and appreciate your patience in answering me!

I understand and appreciate that my risk was low, and that's comforting to hear.  It seems even the brief eye exposure to semen wasn't too much of a concern for you.  (And as I said, I believe my partner does test as he says and was negative recently).

Understood re the symptoms being similar to ARS (but then, as you point out, a lot of things are).  It is good to know the antibody tests are typically positive a few days after ARS symptoms begin - I will probably do an extra followup test or two in between my regular ones just for peace of mind.  I suppose it stands to reason you test positive soon after ARS since I assume the symptoms are responses to antibodies fighting off the initial phase of infection.  

Good to know not to worry too much about mouth irritation (that isn't actively bleeding, etc.).

Thanks again for the help!