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Please Help Assess Doc - Possible ARS?
Jun 18, 2009

Hi Doc.

First off and just like some on this site, I want to personally thank you for all the work you do. This site has given me some piece of mind through all the anguish these past couple of weeks. I have looked through many postings and my risk of exposure seems to be very low but I'm really hoping you can confirm my findings. Below are the details of my possible HIV exposure:

The event took place late Saturday 5/30 early Sunday 5/31. Being bicurious and tyring to hide it, I went through an online site and met a gay guy (probably a bad idea as I'm sure the risk is greater) that was in the US on a business trip from Poland. We ended up engaging in unprotected oral sex (both gave and received deep throating at times), rimming (I only received), and eventually protected anal sex with a condom (I received)no ejaculation. We took it to the shower where we both gave each other hand jobs and oral sex until eventually ejaculated (in the bathtub not in the mouth). After showering he performed oral on me again until I came.

I wasn't worried since I know about the low risk with oral sex, however, I started to feel 'flu-like' symptoms coming on by Monday. Fever started on Tuesday and by Wednesday I had swollen lymph nodes on my neck and a sore throat. I had night sweats Wednesday night. I went to the doctor thinking it was bacterial and I was prescribled Azithromycin(z-pack)which I took the same day. By Friday I was feeling much better, though my sore throat was still persistent (something that led me to believe it was a virus vs. bacterial infection). By Saturday, I was much better and was feeling great. Monday came along and I started getting that malaise feeling again and noticed the back of my tongue was turning white. Until this day I have a white/hairy coating with red dots in the back of my tongue. In addition, I have had a very minor sorethroat (almost comes and goes). I had one more night of night sweats. I haven't had any high fever since the inital symptoms but at times feels like I get low-grade/virtually no fever. I have also had discomfort in my lower abdominals. Doesn't really hurt but it's almost like gas. I have had diarrhea for the past two days (seems better today) but the bothersome feeling is still persistent in my lower abs in the pelvic region. I also get a slight burning feeling in the same area. No rash with any of these symptoms.

Knowing all this information and symptoms can you assess my risk? Can these symptoms be ARS? Do you recommend I get an HIV test? Is it possible that the inital symptoms and the symptoms I got after the Z-pack are two different circumstances? What really worries me is that I got symptoms was starting to feel better for a couple of days and then I started getting other symptoms. What if the other symptoms are the initial onset of ARS?

I'm going to the doctor on Thursday to get a general check up in case but I was also thinking about getting a DNA by PCR test ASAP to try and rule out possibility of HIV infection. I will probably also be testing for all STD's.

Please let me know your thoughts. If it's not ARS any idea what else it could be? It's been a nightmare these past couple of weeks, even though I know my risk was low and symptoms from what I read in your forum don't start any earlier than the 2-4 week period. I was reading to see if anyone experienced symptoms and exposure similar to me but it's all nuggets here and there from different postings - nothing consistent.

Your response is greatly appreciated as I await in agony. I'm hoping you response will put this matter to rest.

Thanks so much doctor.

Steve

Response from Dr. Frascino

Hi Steve,

Bi-curious, eh? And you had unprotected insertive and receptive oral sex, rimming and protected receptive anal sex? That doesn't sound "curious" to me, but rather like the opening scene in a gay porno flick.

Regarding "symptoms," they are notoriously unreliable in predicting who is and is not HIV infected. The reason to worry or test is related solely to HIV-exposure risk, not the presence of absence of symptoms. Having said that, you are correct: Symptoms beginning several days after an exposure would not be related to HIV ARS (too early).

Your overall HIV-acquisition risk is very low, assuming the latex condom was used properly and did not break.

The guidelines for HIV screening recommend an HIV-antibody test at the three-month mark. PCR testing (RNA or DNA) is not recommended for routine screening due to the rate of false positives, other technical considerations and cost.

If not ARS, what could be causing your symptoms? Stress, guilt and anxiety would top my list.

My advice would include getting a single HIV-antibody test at three months and seeking counseling to explore sexual orientation issues.

Good luck.

Dr. Bob



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