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how soon can ARS symptoms appear
May 19, 2008

OK, I feel like a dope. I emailed you yesterday w/o fully checking through the archives. (You are a busy guy!) I found some encouraging posts, but want to clarify.

Most of the info said that ARS takes at least a week or more to manifest symptoms after exposure.

Is that always the case? I realize there are no absolutes... but have there been cases where symptoms appeared inside of 48 hours?

My (pathetic) story:

During lap dance, the stripper placed my finger inside her vagina, which I removed quickly (no cuts on finger).

Next she placed her own fingers inside her vagina. Then she licked them. She then pretented to go down on me... but then quickly pulled my shorts down and briefly put my penis in her mouth for a moment giving it a quick, hard suck on the way out. (It hurt a bit; don't think she bit; don't think it broke skin, although I had some rawness/blood blistering type marks on the inner part of the tip the next day).

Afterwards, I went to the restroom and washed my hands and urinated. That was about 1 or 2 am on Sunday.

Now the timeline of symptoms: Went to bed around 4am Sunday

Sun - got up at 8am for full day of manual work; very worried about what happended. I felt hungover and couldn't eat all day.

Mon - still very worried, and felt weird all day. Not much of an appetite. At about 6pm (~41 hours after the lap dance) I got a rash. It was like a mild sunburn on the 'love handle' areas, and spread upwards to my lats and downwards to my upper thighs. This absolutely freaked me out.The strange malaise feeling intensified and felt almost surreal, like I was underwater or in a dream. It was terrifying. Also had small pangs in my left groin.

Tues - woke up and had mild diarrhea. Think I'd had mild night sweat on my forehead. The rash was still present, but starting to fade. Better appetite.

Wed - woke up with a little sweat on forehead, and had mild diarrhea again. Rash almost gone. Normal appetite.

Thrus - stools back to normal. Rash pretty much gone. Occasional small pangs in left groin continue.

Almost 3 weeks later, I'm now getting a bit of a sore throat, and occasional minor but sharp, pains in my forehead behind my eyes. And starting to hawk up a bit of green flem in the mornings, like after being sick.

So... I've read the posts on the potential exposure and risk stats. Would seem chances are pretty low that I picked up HIV. But the symptoms are really worring me, and - I can't let it go.

So, I told my wife. She has lost all respect for me, but standing by me.

I had a PCR done at 3 days, but afterwards learned about the high false positive rate and am therefore afraid to check it.

Thursday will be 25 days and I'll be HIV/HepC, etc. tested. Then I'll go back at 6 weeks and 3 months.

Can you tell me:

1) Is is possible that HIV infection can start in under 48 hours and disappear w/in 3-4 days?

2) Are there any documented cases of initial HIV infection sypmptoms occuring and leaving so quickly?

3) The mind can cause weird tricks... but rash?!

4) If the stripper had high concentrations of the virus in her vaginal fluid (menstrating for example) or had blood in her mouth... and I did get a small tear in the skin, what are the chances of infection? I've read syliva is a tough place for the virus to live... and air kills it on contact (contacting air on the journey from vagina to the mouth via the finger)? She had a shot of Tequilla a few minutes before, if that makes a difference.

Thank you for any insight you can provide. I can tell you are really helping people. You've got another contributor.

Lesson learned! Thank you.

Response from Dr. Frascino

Hello,

Responding to your specific questions first:

1. No.

2. Not that I am aware of.

3. The mind can play weird trick, yes! Rash can be caused by gazillions of things other than HIV!

4. HIV-acquisition risk would be negligible to nonexistent.

As for your evening at the local Badda Bing, your overall HIV-acquisition risk is negligible. Your symptoms are not consistent with or worrisome for HIV acute retroviral syndrome (ARS).

I'm glad you leveled with your wife. It's the first step in confronting your guilt and fears and also the first step in regaining her respect and rebuilding your relationship.

Testing guidelines for a potential HIV exposure continue to recommend an FDA-approved anti-HIV antibody test (ELISA, EIA, rapid test, etc.) at the three-month mark. Antibody tests taken prior to three months are not considered to be definitive.

Thank you for your interest in contributing to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). All gifts are tax-deductible and warmly appreciated. In return I'm sending you my good-luck karma that your three-month definitive HIV test will be negative. I'm very confident it will indeed be negative!

Good luck.

Dr. Bob



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