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Could ARS develop within 2 days if a more deadly subtype?
Apr 18, 2012

Dear Experts, I had protective insertive anal sex with a ladyboy (male to female transsexual) sex worker in Thailand. This is the only person I've been with in a year, and it was one incident about 5 days ago(Friday night, the day I'm posting this is Wednesday). I have known her for a month but didn't have sex with her until 5 days ago.

The details of the incident: -I wore two condoms, which I now realize is bad because of the friction. As far as I know they didn't break. It was dark so I can't be certain. But I had some pre-semen or possibly semen that was at the tip, still inside the condoms, so I'm assuming it would have leaked out if it had broken or I would have noticed or felt something.

-It lasted a total of maybe 15 to 30 seconds. I was nervous about the whole thing and worried the condoms would break if I kept at it so I stopped and made up an excuse.

-She used her saliva to lubricate the area, which has me now concerned that since she does this regularly and doesn't use proper lubrication, there could have been abrasions or areas that could easily bleed from previous trauma.

I drank the night of the incident and didn't sleep all night until the next day (Saturday afternoon). I woke up later in the evening feeling fatigued and slight nausea and assumed it was a hangover, though no headache. The next day, on Sunday, I felt a little better in the afternoon and walked around, but by nighttime I started to develop more severe fatigue and a general ill-type feeling (warm feeling you get when you have the flu).

The next day, Monday, the fatigue was worse. I went to the hospital here to get STD tested and all they really did was take my temperature and get a urine sample after I said I felt weak. Doctor said I had low levels of white blood cells in my urine and a low fever of 39 Celsius. He said he didn't see any signs of STD's in my urine and I asked if I could get on PEP because I was worried about it being HIV and he said I'd have to bring her in to get tested to get on it. He gave me antibiotics "just in case", I'm assuming just in case it was a bacterial infection, as well as some paracetamol.

Today is Wednesday, it's now been 5 days since the incident and I'm still feeling fatigued with what feels like the flu. Though I haven't had any headaches, coughing, sore throat, stuffy nose, or any type of congestion. Just mostly fatigue, fever, and ringing in my ears (especially at night).

My symptoms showed up within 48 hours after this incident, and I've read many studies that say that it takes 2 to 4 weeks on average, and as little as 5 days for ARS to show up. I have not seen any studies that say less than this, and Dr. Bob said on one of his past posts that "the body just doesn't work like that" in response to somebody who was worried about symptoms that showed up 48 hours later.

I have however seen studies that seem to have correlated a connection between a quick onset of ARS symptoms and a quick onset of AIDS and death. I have also read studies that Subtype-E, the most prevalent strain of HIV in Thailand, develops into AIDS about 4-5 years earlier than most other subtypes. Every study that has stated that the earliest ARS occurs is at 5 days has involved people in Western countries. I have not seen any studies that talk about the onset of ARS in developing countries with different types of strains, particular this Subtype-E in Thailand.

So my question is, when Dr. Bob said that "the body just doesn't work like that", was his response mainly based on these studies on western people, or is this based on a general medical knowledge that the body can't do that, regardless of the strain? I'm very worried now, especially with the absence of headache, coughing, runny nose etc, and the quick onset directly after this risky incident. I plan to get tested at the 30 day mark and then again at 3 months, but I was just wondering if you know of any studies that involved ARS in this particular Subtype or if it really is impossible for symptoms to show up within 48 hours, regardless of the strain, as Dr. Bob said.

Thank you, Jordan

Response from Ms. Southall

Hi Jordan Dr Bob was speaking of everyone's body. It just does not respond that way. Your best bet to give you the peace of mind that I see from your writing is to get tested. At 3 months from any type of exposure if your test comes back negative then you are negative from that experience. I would highly recommend for your peace of mind getting tested.

Be well and stay safe, Shannon



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