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Exposure and symptoms questions
Sep 9, 2011

Hi Dr. McGowan,

I hope this email finds you well. I stumbled upon your forum and thought I would take a chance and see if you'd be able to respond to my question.

I had a potential exposure (heterosexual, unprotected) in late July 2011 (almost 7 weeks ago). I know that symptoms vary between people, so I am not planning on using your anticipated response to my query in lieu of getting tested--I will do that at precisely 12 weeks.

I have been dealing with a very red throat (specifically the anterior pillars) for at least the past 3-4 weeks (that is when I believe I first noticed). There really isn't pain, no swelling of my tonsils from what I can tell) and no lesions on them. Just noticeable redness in this area of the throat. In addition, I am experiencing significant pressure in my ears (like I just stepped off an airplane). I have had some headaches during this period, as well as possibly being slightly feverish 2 weeks ago for a few days (I think I was feverish...can't tell if it was that, the hot weather, or the anxiety). I have read that primary HIV infection can mimic other viral illnesses such as tonsillitis, but when I read about some of the commonly presented symptoms of ARS I haven't seen bright red pillars of the fauces or otitis media associated with primary infection.

Sorry for the lengthy detail, I'll cut to my questions: (1) In your clinical experience, are symptoms similar to mine (bright red anterior tonsillar area and ear pressure) oft presented in primary infection or shortly thereafter? (2) I know duration of symptoms vary as well, but would this long term (3+ weeks) presentation be common of ARS symptoms?

Really appreciate your consideration. Just hoping to gather a little more information while I wait to test, and not try to be diagnosed in the meantime. Just seems weird for someone who has NEVER experienced these symptoms.

Best wishes~

Response from Dr. McGowan

A sore throat can be part of the syndrome (of course yours is not sore) but otitis would be unlikely. The viral syndrome that is most commonly seen is akin to mononucleosis...fever, swollen lymph nodes (glands), sometimes a rash on the trunk and extremities (arms/legs), sores in the mouth and gums. We have also seen people with diarrhea (including bloody diarrhea). The timing of ARS symptoms is usually 2-3 weeks after exposure. So this would be late. Look into the possibility of a sexually transmitted infection such as chlamydia or gonorrhea if you had unprotected oral sex.

Best, Joe

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