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What else could it be besides Acute Retroviral Syndrome?
May 5, 2010

I performed oral sex on a man of unknown serostatus eight days ago. He was well-endowed (10 inches) and the sex was a bit rough as he battered my throat with his thrusts. Ultimately, I was too slow in pulling off his penis when he ejaculated and got maybe half to a teaspoon of semen in my mouth. I immediately tried to produce as much saliva as I could, spit it out, rinsed and gargled with warm water, and gargled again with mouthwash once I got home an hour later. Unfortunately, ever since then I have had a sore throat that didn't lessen in intensity over time during the 1st week; it only got worse. Then I began to experience fatigue and muscle and joint ache. I have been almost constantly nauseated and also suffered with a brief bout of urgent, unexplained diarrhea. I have felt hot and seem to feel worse at night, though my temperature has read normal 98.8F. (Normal for me is 97.9-98.1F) The lymph nodes under my arms and at my jaw/ear were sore for a day or so. I have not noticed any rash though the soles of my feet were a bit dry and scaly. Though I have had a general feeling of malaise I have not been bed ridden or as sick as I have hear others have been when seroconverting. My throat and cervical lymph nodes are still sore though not quite as bad as before. I am freaking out fearing that after 15 years of regular testing during the vaccine preparedness studies and over 15 years in HIV prevention work, I may have seroconverted and let myself and so many others down. Where I am in DC and with my insurance, post-exposure prophylaxis was sadly not an option. I will get an EIA test tomorrow (and a PCR if it is available) but am I worrying myself for nothing? Or do I have cause for concern? Could this be anything OTHER than ARS? I have been worried in the past, but I have never before felt this way physically following sex? I know you fielded a similar question yesterday, but I cannot ask any of my former prevention/treatment friends and colleagues because I am too embarrassed.

Response from Dr. Frascino

Hi

Actually I field questions like this almost on a daily basis. I guess you're "it" for today. However, I must admit a true 10-incher is somewhat rare (unless it's in "Manhunt/Internet inches," in which case it's really common). Assuming your Mr. Big had a full 10-inch anaconda for a trouser snake, I can understand why your throat was "battered" by his thrusting super-sized tallywhacker. This may also account for your throat being sore.

As for your other symptoms -- fatigue, muscle/joint aches and brief bout of the Hershey squirts -- these are certainly not diagnostic or even all that suggestive of HIV acute retroviral syndrome. There are gazillions of other conditions that can cause these very common symptoms, including anxiety.

Oral sex carries only a low risk for HIV acquisition. PEP would not be warranted for this type of exposure.

I would suggest you ratchet your "freak-out" anxiety levels down significantly. Get a single HIV-screening test at the three-month mark. The odds remain astronomically in your favor that you did not contract HIV from Mr. Big's big-boy.

Good luck.

Dr. Bob



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