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ARS symptoms - anxious about HIV+

Question: 

Hi,

my exposure was on the 22nd October 2013. Unfortunately the doctor at the hospital denied PEP when I asked for it.

I started to experience diarrhoe, pain in joints and muscles on day 7 after exposure. At this stage I wasn't sure if they might come from the antibiotics the told me to take to cure a possible Chlamydia/Gonorrhea infection. On day 8 my right lymph node near my grain was swollen and unbelievable painful. I decided to get a test (HIV PCR) on day 16 after exposure. Maybe too early but symptoms where hard to explain for me. I got a negative test result back.

On day 20 after exposure the left lymph node near my groin became swollen as well. Then two days the lymph nodes (axiliar) started to react with inflammation. A burning pain, swollen and painful. On day 25 after exposure I could sense it is less painful to touch my lymph nodes (groin and axiliar). Unfortunately the lymph nodes hollow of both kees were swollen and painful. Today is day28 after exposure and all lymph nodes are still slighty swollen. The most painful lymph nodes are still at the hollow of my knees. I can't stand longer than five minutes. In addition my legs are burning like hell. I can't sleep longer than six hours although I was used to sleep much longer. Nightsweats from time to time, some chills last week and a sore throat.

Surprisingly I had no fever yet. Good or bad sign? I don't know....

Well regarding my exposure- making a long story short: a sex worker with lots of red rash mostly on her breast and back and an ulcus or herpes simplex infection at their lip, unprotected oral sex while I am 90% sure I had an open herpes genitalis wound at my penis, 50% sure that we had protected anal & vaginal sex. Just to clarify: We had oral (unprotected) sex and vaginal and anal sex (hopefully protected). I can't tell anymore if the condom were allright after I had some trouble inserting my penis into her anus.

Accordingly to my symptoms: What is your experience when it comes to lymph nodes swollen and painful all over the body. My HIV PCR result useless because I went to early for the test and swollen lymph nodes occured after my HIV PCR was taken?

In addition I think I am infected with Syphilis. A black dot at my penis which wasn't there yesterday. It doesn't look good :( Due to the lymph nodes I was tested on Syphilis on Tuesday and have to wait for the result.

Should I get tested now again for HIV with an antigen test or should i wait till week 6 (after exposure)?

Any comment appreciated. Thanks in advance!

Answer: 

Hello and thank you for using the AIDS Vancouver Helpline as your source of HIV-related information.

First and foremost, HIV does not discriminate based on characteristics of an individual (age, gender, ethnicity, sexual orientation, occupation or any other socio-economic status). Rather, it is the activity one engages in (unprotected anal sex, unprotected anal sex or sharing needles) that poses a high risk for HIV transmission. In addition to that, we cannot diagnosed people by looking at them or based on their occupation; testing is the only way to know one's HIV status.

Post-exposure prophylaxis (PEP) is only give to people who actually have had exposure to the virus and/or engaged in high risk activities. Many people who took PEP wish not to; PEP is the same treatment regimen as HIV therapy and it is very hard on the body and people suffer quite severe side effects.

Receiving oral sex is considered a negligible risk, which means there has never been a reported case of HIV infection in this way although there may be an exchange of bodily fluids during this activity. Someone who is performing oral sex has higher possibility of acquiring HIV; in your case, this woman but not you.
Safer/protected sex is a low risk; however, there is no way the virus or bacteria can go through latex, polyurethane or nitrile as long as a condom is used correctly and there is no breakage or slipping off of it. It seems like you are not so certain whether you used a condom or not; if you were not heavily intoxicated at that time, you would know. Having difficulty inserting your penis to her anus is nothing to do with the usage of condom; it could be due to lack of lubrication or your penis not being hard enough, perhaps?! But you have done right things by seeking a medical attention when you feel you needed it.

Moving on to symptoms.
Acute Retroviral Syndromes (ARS) looks like a strong flu with high fever, which may show up 2-6 weeks after the point of infection and only lasting for up to 7-10 days like any other cold/flu. All those symptoms you have experienced are not early symptoms of HIV. Like you mentioned, diarrhea you had is likely the result of you taking antibiotics; as you may know, antibiotics can kill the good bacteria in the stomach, causing people to have diarrhea.

PCR test looks for the genetic materials of the virus itself. Although I'm not sure when you got tested with this, it is an indicator of your status. With an antibody test, up to 95% of infection are detectable within 4-6 weeks, with 12 weeks being conclusive. Thus it is up to you if you want to be tested at this time (4 weeks post possible exposure of your concern) or wait till 6 weeks. Whichever you choose, it will give you a good indicator of your status.
A painless open sore, which is usually red, develops at the primary stage of Syphilis infection. It is great to hear that you got checked up so I encourage you to further discuss with your doctor.

To sum up, the activities you engaged in pose negligible to low risk. And your test result with PCR is an indicator of your status. I encourage you to keep teaming up with a doctor to deal with any health concerns you may have.

Hopefully you find the information helpful.
Please feel free to write us back if you have any other questions/concerns.

Stay healthy and keep smiling,
Yoshiko