Q. Why am I having fatigue, increased saliva and throat pain after unprotected sex?

Answered by
Dr. Kiran Anaparthi
and medically reviewed by iCliniq medical review team.
Published on Nov 10, 2018

Hello doctor,

I had unprotected sex with a sex worker three and a half months ago. Two months later, I started having ARS symptoms, fatigue, diarrhea, dizziness, sore throat, mouth ulcers. Just a day before that I had protected sex with a sex worker but my penis was not fully erect and did not insert deeply. So I think contact with the vagina may have occurred, but I do not remember, not sure. But I got an unprotected blow job or oral sex from her. Two days later, I got a p24 antibody combo test which was negative. A few days later I got DNA PCR which was negative.

11 weeks after first exposure, I got western blot which is negative. 12 weeks after first exposure, I got CMIA rapid which is negative. Two days later, I got RNA PCR for HIV 1 and 2 which were negative. This was 30 days after second exposure. Six weeks later, I got an antibody p24 combo CMIA which was negative. I still have symptoms of fatigue, increased saliva highly, throat pain. I am very worried. Please tell if my tests are conclusive. I read about people seroconverting late and I am worried. Also, one another person whose status I do not know also had daily dizziness, diarrhea, mouth ulcers and leg pain like me. Please help.

Dr. Kiran Anaparthi

Family Physician HIV/AIDS Specialist
#

Hi,

Welcome to icliniq.com.

First, HIV symptoms are non-specific and are common to most infection and are referred to as flu-like symptoms. HIV infection symptoms in the acute phase often go undetected and are self-healed without any active intervention due to an intact immune system. These symptoms are only effective if they occur 2 to 5 years after exposure due to a crippled immune system. So far, in your condition, these occurring infections are stress related due to over activity of hormones (vagal stimulation) causing diarrhoea, running nose, sore throat. Mouth ulcers are moreover due to vit B complex deficiencies, dizziness can be due to a simple ear problem. So, do not worry about being infected, once the fourth generation is negetive after 28 days, then nothing to worry. You are free of infection.


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Thank you doctor,

Do I need to get any other test? I read of some people seroconverting late up to two years which is making me tensed. Do I need to repeat PCR? Should I check for any infection like chikungunya so that this anxiety is relieved and the cause is identified? How sensitive are the tests that I did? Is there any chance of missing it in tests?

Dr. Kiran Anaparthi

Family Physician HIV/AIDS Specialist
#

Hi,

Welcome back to icliniq.com.

Delayed seroconversion is only a vague term as there is no documented evidence for the same. Most of the posted replies are a hoax and nothing in close proximity to real sense. Fourth generation and PCR are 97 % specific and 95 % sensitive. You do not need any repeat test. Chikungunya is a viral infection and any other tests pertaining to chikungunya and dengue are not accepted. I would request you to go through antigen and antibody immune complexes. Once an antigen is formed, it remains in the body and so does antibodies. That is why serological tests are a gold standard on detection. So, it is always assumed to be reactive once antibodies are formed against an antigen. There will not be any delay if the antigen is in the body. So, do not worry about the incidence.


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Thank you doctor,

Now, other symptoms have subsided but I still have a sore throat. Does HIV cause a chronic sore throat like this? I also have some fatigue and body aches. I am very worried. Panicking a lot on how I had exact same symptoms exactly two months after sex. I never suffered such extreme fatigue and dizziness before in life.

Dr. Kiran Anaparthi

Family Physician HIV/AIDS Specialist
#

Hi,

Welcome back to icliniq.com.

Before answering questions, I just want to say one thing, this is not the world of HIV and HIV is the only virus. Any virus infection, involving any organ in the body, can cause myalgia, easy fatigue and there are approximately 122 strains of the virus that cause a sore throat in excess to bacteria which normally colonize in the pharyngeal mucosa.

Coming to mouth ulcers, most of you are confusing with candidiasis to ulceration. Mostly we describe it as ulceration to let common people understand easily, but actually, we refer to candidiasis and candidiasis is caused by a fungus which can only infect a person with severe immune suppression as in AIDS, kidney disease, cancer, uncontrolled diabetes, etc. The only rule in medicine is, never impose every disease you read, as every disease has a common problem. That is why we diagnose and take help of investigation to confirm our diagnosis.

In your case, it is not HIV, it may be simple adenovirus infection or common cold virus causing sore throat and simple riboflavin deficiencies causing oral ulcers. So, nothing to worry. never impart everything. It needs the experience to diagnose a thing.


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Thank you doctor,

I have read that the calculation of window periods (for example 30 days for fourth generation test) is based on B subtype in some places, while in others, the subtype is C for which exact window periods are not known. I also have weight loss (3 to 4 kg), mouth ulcers, sore throat, and body aches now. It has been more than three months since my first exposure which was unprotected vaginal sex with a girl. My second exposure was seven weeks back in which I had protected vaginal sex (but I am thinking maybe condom was broken because I was trying to insert a non-fully erect penis by force with hand, but I do not remember it being broken or anything). I tested fourth generation test two days back also, which was negative. I had RNA PCR one month after this second exposure which was negative. I am in a lot of panics as these window periods are confusing me and because of my symptoms which are common or similar to HIV. Please help, I do not know what else to do, thinking of this only daily all day.

Dr. Kiran Anaparthi

Family Physician HIV/AIDS Specialist
#

Hi,

Welcome back to icliniq.com.

Coming to your question on subtypes in different countries, you need to understand basic concepts. HIV virus has M, N, O, P types of which M is major and most predominant and is the cause if pandemic (spread to other parts). M is sub-divided, or subtypes to A, B, to K of which C type is the most and constitute 80 % of infection. So, the typing of this is based on the envelope protein present on HIV virus but will not use core proteins. Envelope proteins vary and have different shades because HIV mutates on daily basis, and most of these mutations render virus inactive and not infectious but only those bring infectious rendered to be classified.

But, core proteins like p24 will remain the same. So, it is used for testing and remain a gold standard. Whether it is A or any other subtype, it can be identified with fourth generation test and you can get other tests to validate its reports. Like, western blot, it is a test that simply differentiates all protein particle and identifies them, irrespective of the subtype. which will be added benefit.

Next, NAT (nucleic acid amplification testing) test, which readily detects nucleic acids of HIV, as the genome of the virus will not change much. Or, a quantitative test like viral load counts. So, if you really feel that you are having HIV by very rare strains, and having complaints, then your body should have very high viral load because only very high viral load can give such symptoms. So, get tested with viral load. Again, if you feel wrong on viral load for very rare strain, do remember that viral load is the test of copies of viral particles, so it does not need to be specific for the virus. It just counts except HIV 2 (which will be easily identifiable in other tests). Take care.


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