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How soon can infection acute symptoms appear?
May 12, 2009

Hello Doc!

I started freaking out (again) - on Fri evening I had protected receptive anal intercourse with an unknown guy. After he came once he continued the intercourse without changing the condom. At some point the condom broke while he was inserting his penis and he withdrew immediately - at least that's what he said; I couldn't notice that the condom broke. So I cannot tell how large the contamination with his semen was. Anyway I rinsed the anal mucosa with cold water. The next afternoon I realised since I didn't know his HIV status and the TRUE extent of contact with his semen the whole exposure would not be as low risk as I initially thought. After doing some reading (radiologist resident here) I found out PEP is given in case of non-occupational exposures as well and would be indicated in such a case as mine. Ran to the hospital where I got the PEP, some 25 hours after the incident. Is it really crucial that PEP begins STRICTLY within 24 hours and 25 hours migght be too late already?

The whole anxiety got a lot worse when on the afternoon after exposure (before getting the PEP) a small (approx. 6-7 mm) lymph node in in front of my left ear got a bit firm and was (still is) well palpable throught the slightly reddened skin over it. Now (2 days later) another even smaller node with reddened overlying skin is palpable behind my left ear / mastoid. IS IT REALLY POSSIBLE for lymph nodes to become firm / slightly swollen within 2-3 days after an HIV infection?

For fairness only: I had some dental treatment which involved some bleeding and pain of the gums the day before the encounter.

Response from Dr. Frascino

Hi Radiology Resident,

PEP (post-exposure prophylaxis) should be started as soon as possible and no later than 72 hours after an HIV exposure. I would suggest you download a copy of the updated guidelines for PEP in both the occupational (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm) and nonoccupational (www.cdc.gov/mmwr/PDF/rr/rr5402.pdf ) settings. This is information that as a physician and sexually active gay man you should be well versed in.

The symptoms associated with acute retroviral syndrome (ARS) following HIV primary infection take several weeks (not several hours or days)to become manifest. Consequently your isolated lymphadenopathy would not be related to HIV. I'm a bit surprised you made it through medical school without a better working knowledge of HIV disease. I think it's time for a refresher course. A good place to start would be with the wealth of information on this Web site, in its archives and on the related links. Have a look!

Good luck. Get informed!

Dr. Bob



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