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ARS Symptoms During PEP?
Nov 9, 2009

Hi, Dr. Bob. I'm very nervous as I write this but I'll do my best. On Nov 1st. around 6 am I had had to much too drink and I had unprotected sex with a prostitute in Bangkok. I started out using a condom, then she took it off a minute or two later and gave me oral. Then we started vaginal sex again without the condom. I finished once, then we did it again without a condom. It wasn't a long time, maybe 7 or 8 minutes of sex total and I guess about 15% of it was with a condom. I don't have confirmation that the is HIV positive but I have started getting symptoms.

The next day I started getting worried, and went to the doctor to get PEP. She gave me Stocrin and Truvada and I started taking it around 32 hours after exposure.

Day 3.5: I notice that the lymph node in my left groin is hard.

Day 4.2: I start having elevated temperature. The temp was only 37.3 Celsius but for me this is elevated. (I have been worried about HIV since Ive been in Thailand and Ive been taking my temperature like crazy. It wasnt above 37 at all in October, and was usually between 36.4 and 36.8) This scared me enough to go back to the doctor, she confirmed the lymph node and said my throat looked very red. She tested for strep and H1N1 and both came back negative. Both of the nodes in my neck were hard briefly but I should say that the node in the left side of my neck has been hard for about a month.

I should also say that I had HIV tests on Aug. 1, Oct. 1, and Nov. 1: all were negative.

Day 6: This is today. My temp. has been above 37 all day. It reached 37.5 after I had taken a shower and has stayed around 37.2 for the rest of the day. The node in my left groin is slightly bigger and now I am noticing some swelling on the right side, but it is small.

Im very worried. Does this sound like it could be PEP failure? Am I on suitable PEP medication? I have read that ARS can start in as little as 5 days. Am I overreacting? Do you think this is the beginning of ARS?

Thank you so much in advance

Response from Dr. Frascino

Hello,

Unprotected sex (unsafe cock banging in Bangkok) does place you at some degree of risk for STDs, including HIV.

1. Your symptoms are not excessively worrisome for HIV acute retroviral syndrome (ARS). "Symptoms" are notoriously unreliable in predicting who is and is not HIV infected. Your concern should be based on your level of risk exposure, not on whether or not symptoms are present.

2. Stocrin and Truvada is as recommended PEP regimen.

3. Yes, I believe you are overreacting.

Good luck on your upcoming post-PEP HIV tests.

Dr. Bob



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