Dear Doc,

I hope you're doing fine and thanks for your time answering and providing relief and accurate information to people around the world. At this moment, I can basically only trust you and your response. I feel totally desperate and isolated where I can't find a clear answer or solution to my stress

I'm 27, homosexual, living in Bahrain in the Middle East. 4 weeks ago I had a risky exposure with another guy. I practiced oral sex to him and I had a little ulcer in my mouth. I recalled there was no exchange or presence of any fluids during that, but I still think that part was risky. Additionally, during anal sex, the condom fell off and I can't tell if there was any direct contact that could've caused HIV infection. For sure, there was no ejaculation. I don't know this guy's HIV status, though he presumes he's clean. Big mistake I made, that I totally regret.

During the first week after the encounter, I suffered from a severe sore throat (started exactly 3 days after and lasted for one full week), a general weakness and a couple of nights with a lot of sweat.

In the second week, I suffered one day of nausea and started feeling some sort of rashes in my skin. I look at the skin and don;t see much, but sometimes I feel itchy. In the past, I suffered from herpes zoster because of stress and it feels similar. As well, I felt some discomfort in my armpit. I don't know if they are the lymph nodes, but it feels like a bit more sensitive that part.

Other few things that have happened to me is like sensitive skin, a few acne-like pimples on my face, itchy around my chest and nipples. As well, I've been extremely hungry lately and thirsty as well.

I think you agree that there is definitely risk involved. If you look at the symptoms, can you tell something? Am I just being very paranoic? I read the web and I can only find troubled things and get completely scared. My life is now like pending from a thread, can't focus at work and anytime I look around, I feel I'm not going to live that or that my life has no meaning. On top, there's no one in this country that I can talk to even doctors are evasive of the topic and foundations are inexistent. Additionally, in case of testing HIV positive you get deported which adds more stress to me and which as well pisses me off because of the ignorance and the way they're tackling this problem.

I heard that there's an HIV duo test because it tests for both HIV antibodies as well as the 'HIV P24 antigen'. Do you recommend taking this test 45 days after exposure? They mention that it's 99.8% accurate after 28 days of exposure. What do you think?

Thanks for your help and light in this troubled time. All I'm looking for is some peace of mind.

Hello Bahrain-Guy,

I continue to be amazed how many folks from Bahrain and other countries in the Middle East write to me in panic about possible HIV. Everyone of whom also complains bitterly about the repressive attitudes about HIV/AIDS in that part of the world. And yet very little seems to be happening to address the ignorance and stigma surrounding the illness or the morally reprehensible behavior of these governments toward those infected with HIV. I would encourage all those living in these areas of the world to demand change. International HIV/AIDS service organizations are ready to help you.

Returning to your current problems, your HIV risk is oral sex with a "little ulcer" and anal sex during which the condom may not have been used properly. There was no ejaculation and the HIV status of your partner is unknown. Overall your HIV-acquisition risk is low.

Regarding symptoms, acute retroviral syndrome (ARS) symptoms manifest themselves two to three weeks after HIV primary infection. Consequently the "symptoms" you experienced three days after your walk on the wild side in Bahrain would not be HIV related. Your subsequent symptoms are not suggestive of or worrisome for HIV ARS or HIV disease.

As for testing, the recommended test for HIV screening remains an HIV-antibody test (EIA, ELISA, rapid test, etc.) at the three-month mark. Yes, fourth generation HIV tests that combine HIV p24 antigen tests with anti-HIV antibody tests are somewhat more likely to detect HIV infection earlier than older assays. However, exactly how much earlier and exactly how reliable these newer tests are remains in question. Consequently, for now, the three-month mark remains the recommended time for testing in most guidelines.

I believe your level of worry exceeds any degree of actual risk. Your fears are most likely amplified by the repressive society in which you currently live. My advice is that you get an HIV-antibody test at the three-month mark. I also suggest you do everything in your power to change both attitudes towards and policies concerning HIV/AIDS in your country.

Good luck.

Dr. Bob