too early for symptoms?

[somatic]

Hi there - try as I might I can't seem to shrug these nagging thoughts that I may have recently contracted HIV. I'm hoping you can give me some reassuring stats whilst I wait for some definite confirmation to the contrary.

Last weekend (Sunday) I was engaging in what I had hoped was safe-sex. I am a gay male, and was receptive in this case. At some point during intercourse my partner removed the condom, and I didn't notice in the heat of the moment. He penetrated me again and it was only after about a minute or so that I realised he was condom-less - at which point, somewhat in shock, I remedied the situation.

I asked this person several times afterwards if he was 'clean', and he was quite vociferous that yes, he was.

I like to think I'm a reasonable judge of character, and very much want to believe this young guy - who, infuriatingly, seemed quite oblivious to the risk he'd put me at.

However a few days later I found myself googling and considering PEP - but then told myself, considering how extreme the side effects sounded, that I was overreacting and so tried to forget about it and proceeded to dive in to work for the week for distraction.

Tuesday and Wednesday nights I was having a lot of trouble sleeping (I also had some GI disturbance presumably from the rigorous session?) and had this playing in the back of my mind also - so knocked myself out with some ambien. Wednesday the glands in my neck were considerably swollen and tender to the touch. This persisted through to Thursday, and has gradually diminished since (it's now Saturday). Having said that, I feel quite wiped out/run down/tired...

Is this too early for ARS to be manifesting (ie starting 3 days post potential exposure)?

I'm hoping it is just the excesses of the weekend catching up with me, and perhaps ambien side effects..

I will be able to speak again with this person tomorrow and hope to get some further reassurance from him. In the meanwhile tho I'm quite spooked.

Thanks in advance

[Edward W Hook, MD]

I think you are doing exactly the right thing to go and see your regular doctor to look for non-HIV reasons for feeling poorly.  

As for HIV, remember that by 2 weeks over half of persons who are going to develop positive tests will have done so.  This is very much in your favor.  I would suggest getting re-tested at 8 week post-exposure.  At that time 98-99% of tests that are going to become positive will be.  When your result comes back negative, as I am confident it will, and given the nature of your exposure, I would take it as proof that you did not get HIV. Take care.  EWH

[somatic]

2.5 week test came back negative (for all STI's).

Still mildly concerned because I am still not feeling very well - extreme malaise, dry throat, slight fever. Could be any number of things I know.

I'll ask my doctor for his opinion, but when do you suggest I get retested?

[Edward W Hook, MD]

I understand your concern but the odds are still hugely in your favor.  Less than 1 in 100 persons who have a "flu-like" illness and seek care in an Emergency Room for it, have the ARS.  He may be naive but its still most unlikely that you have HIV.

You are right that the earliest stage of the infection is the most infectious.  

This is not ARS.  You are overthinking this.   EWH

[somatic]

Sorry just saw the note on 'treatment advice' - so feel free to disregard the last part of my post...

[somatic]

Thanks very much for your response.

I finally spoke again with this person today and he said he has not had 'many partners' and only sleeps with people who 'look OK'. This is my problem with this kid - he is so darn naive. So I'm not feeling overly reassured by anything he had to say - and getting him to comment in the first place was like pulling teeth which didn't help.

I believe him when he says he does not have any confirmed diseases - what worries me is that he may have unwittingly contracted something recently that he could easily have communicated to me.

Isn't the first phase of infection also a time when one is highly infectious too? He tells me he also had a fever last week. Hopefully we have just shared a flu or something like that - but I won't be sleeping well until such a time as I can get some tests done.

I will see a GP tomorrow as I still unusually exhausted, and have had a mild headache for days now :( Again, I'm hoping it is too early for ARS and that I'm just somatasizing, since this came on just a few days after the event.

Hypothetically if I am seroconverting is there anything I could be doing that might help? I'm taking Cat's Claw/Echinacea/Goldenseal in an attempt to give my immune system a leg up.

[Edward W Hook, MD]

As you already know, your risk is low.  Your partner, in addition to betraying your trust as a sex partner, said he did not have HIV and was probably telling the truth.  Even if he did have HIV, his likelihood of infecting you was, at most 1 in 100 (1%).  Thus your risk of infection is very, very low.

As for your symptoms, they are early for the ARS.  They are likely to be due to something else, not HIV.

In terms of what to do, getting a blood test 6-8 weeks from exposure is a good idea but you can have an answer to your concerns even earlier if you can get your partner to go get an HIV test next week.  If he doesn't have HIV, he cannot give it to you.  It seems that if he is willing, that would be the best course and the least he could do to make amends for his betrayal of your confidence.  EWH