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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19306
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello. I have a question regarding possible HIV symptoms.

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I have a question regarding possible HIV symptoms.
I had unprotected sex with a Kenyan sex worker. I started a course of PEP 48 hours after possible exposure. I completed the full course having been late with a couple of pills by a few hours but never completely missed.

It's now been 6 weeks after the possible exposure and two weeks after PEP was finished.
I flew to Thailand a week ago and the day after started feeling unwell.

My symptoms are:
Fatigue (wanting to stay in bed, needing to nap during the day, slight breathlessness)
Feeling 'zoned out'
Slight running nose but bunged up in the morning
Sore throat (went after 2 days)
Nausea (especially in the morning)
After 6 days:
Chesty cough
Slight pain in left side of throat when swallowing
I had diarrhoea this morning (day 7)

The fatigue seems to be better today.

I feel the need to point out some facts about the possible exposure after having read some things online.

The act only lasted a minute or so
I did not ejaculate inside her
I am circumcised

Thanks in advance for any response.
Have you had any HIV testing after completion of the PEP?

Customer: replied 3 years ago.
No. I haven't had a test as I was due to fly to Thailand on the date that the earliest test could be conducted. I am going to have a test done as soon as I return from Thailand which will be 18th April.
Very good, as it is common protocol to check an HIV test about 6 weeks after exposure when PEP is used.

It is unlikely that these symptoms represent acute HIV symptoms.

First, the average risk to a male of a single episode of penile-vaginal sex with an HIV infected women is about 0.05%, meaning that 99.95% do not become infected. There are other factors that can affect risk, including the viral load of the female and the general health of the male, but in standard situations, the average risk is 0.05%.

This risk assumes a standard sexual encounter, so a brief sexual encounter of a minute or so and an incomplete act that did not result in ejaculation would carry a lower risk.

The risk would obviously also be much lower since the PEP was taken. The fact that a few dose were late by a few hours will not significantly decrease the effectiveness of the PEP.

The symptoms that you describe also are not typical for an acute HIV infection. Certainly, some of the symptoms are typical, such as a sore throat, nausea, and diarrhoea. However, there also are several symptoms that are atypical, such as the runny nose and the chesty cough, and there are other common symptoms that you do not describe, such as fever and swollen lymph nodes.

Of course, it is impossible to exclude the possibility of HIV based solely on symptoms, so it is still appropriate to be tested, but it is unlikely that this represents an acute HIV infection.

If I can provide any further information or clarification, please let me know.

Customer: replied 3 years ago.
Thanks for your help doctor. I guess I'm just after some reassurance. I've also read that my symptoms could be down to jet lag as I crossed 7 time zones from west to east. I would of thought that these symptoms would be gone by now (1 week after flying). But as you can probably appreciate HIV has been at the forefront of my mind.
Actually, the most common cause of symptoms typical for acute HIV that occur during the window of concern is another generic viral infection. In certain studies looking at people with a high risk HIV exposure, most of the people that develop fever, sore throat, swollen lymph nodes ultimately are found to not have HIV, and it is thought that the symptoms were likely related to another generic viral infection. Of course, we do not have direct tests for most generic viral infections, but that appears to be the case. You are correct that jet lag symptoms would be gone after 1 week has passed, but it is common for generic viral infections to persist for a week.

Dr. D. Love and 3 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Once again, thanks for your time and for answering my questions.