Oral Symptoms and HIV Concerns After Unprotected Sex

Oral symptoms raising suspicion for HIV?

Hello Doctor: Nine weeks ago, I had unprotected sexual intercourse with a sex worker (two minutes of unprotected vaginal intercourse and three minutes of oral sex performed on her).
About three weeks later, I experienced unexplained nasal congestion that lasted for four days, along with a scratchy sensation in my throat without pain.
When I moved my throat without swallowing, it produced a sound, and I felt something sticky in my throat, but there was no phlegm, and the nasal discharge was clear and white.
My first concern about HIV arose when I noticed one or two painless, itchy red spots on my arm and chest, and two larger, firmer red spots on my heels.
These symptoms were new to me and appeared three weeks after the sexual encounter.
In the fourth week, I noticed my mouth was drier and stickier than before, and I developed white patches resembling oral thrush on the back and left side of my tongue, with white stripes and circles on the sides and tip of my tongue.
When I touched the frenulum (the bottom of my mouth) with my tongue, it felt rough.
I am concerned that these symptoms might be due to a Candida infection caused by a weakened immune system.
In the fifth week, I noticed a small swelling just above the Adam's apple on the left side of my neck, which I suspect might be swollen lymph nodes, but the symptoms only lasted for five days and then disappeared.
On the 35th day after the sexual encounter, I went to the hospital for an anonymous HIV test, and the result was negative.
However, I still have oral symptoms that persist, while the other symptoms have resolved.
The oral symptoms make me worry about oral thrush or hairy leukoplakia.
The testing personnel told me that a negative result means I shouldn't worry too much, and that acute infection would not present with oral thrush symptoms.
I also did not have a fever, so there is no need to suspect HIV infection.
If we can rule out the possibility of HIV infection, could the above symptoms be due to an oral infection from another sexually transmitted infection? I would appreciate your clarification on this matter.
Thank you! Additionally, I had an antigen-antibody HIV Ag/Ab combo test (not a rapid test) in the eighth week, and the result was negative.
Can I largely rule out HIV? Recently, I have been anxious due to these concerns, especially since my family members have also experienced unexplained nasal congestion for about a week, and I am worried about the possibility of transmission through shared bathroom items or saliva from eating together.
Other family members also have mild throat cough symptoms.
I understand that I need to wait three months without detecting antibodies to be considered safe, but I hope to receive your accurate response to alleviate unnecessary concerns.
Thank you once again!

Andy, 20~29 year old female. Ask Date: 2023/06/02

Dr. Liao Zhongxin reply Internal Medicine

According to the Centers for Disease Control data, there are three main transmission routes for HIV:
(A) Sexual transmission: Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individual carries a risk of infection.

(B) Blood transmission:
(1) Receiving or coming into contact with blood or blood products contaminated with HIV.

(2) Sharing needles, syringes, or diluents with individuals who inject drugs and are HIV-positive.

(3) Receiving an organ transplant from an HIV-infected donor.

(C) Vertical transmission from mother to child: An infant can acquire HIV from an infected mother during pregnancy, childbirth, or breastfeeding.

B.
Latency period: There are two interpretations of the latency period following HIV infection:
(A) Symptoms resembling a cold may appear approximately 2-6 weeks after infection, indicating primary infection.

(B) The period from HIV infection to the appearance of clinical symptoms typically lasts 5-10 years (currently referred to as the asymptomatic or subclinical phase).
However, the progression of HIV infection can vary significantly among individuals.
During the window period or latency period, many patients may be asymptomatic, which can lead to gaps in HIV prevention efforts due to continued high-risk behaviors.

C.
Window period: After HIV infection, there is a period during which HIV antigens or antibodies may not be detectable in blood or bodily fluids.
This time, during which an individual is infected but cannot be tested positive, is known as the window period.
Generally, the window period lasts about 3-12 weeks, depending on the testing method used.
For specific testing options, individuals should consult their testing facility.
During the window period, the virus is present in the body, and the individual is infectious.
If someone engages in unprotected sex and later tests negative, but suspects they may be infected, they should retest after the window period while avoiding unprotected sexual activity during this time.
Therefore, it is understood that the window period can last from three to six months, and safe sexual practices should be maintained during this time.

Reply Date: 2023/06/02

More Info

It sounds like you have been experiencing a range of symptoms and concerns following unprotected sexual encounters, particularly regarding the possibility of HIV infection and other oral health issues. Let's break down your situation and address your concerns comprehensively.

First and foremost, it's important to understand that the risk of HIV transmission through oral sex is significantly lower than through vaginal or anal intercourse, especially when there are no open sores or bleeding gums involved. However, it is not zero, and certain factors can increase the risk, such as the presence of other sexually transmitted infections (STIs), oral lesions, or bleeding gums.

You mentioned experiencing symptoms such as nasal congestion, a scratchy throat, and the development of red spots on your skin. These symptoms can be concerning, but they are not definitive indicators of HIV infection. In fact, many of these symptoms can be attributed to common viral infections, allergies, or even anxiety-related responses to your situation. The presence of a dry mouth and white patches on your tongue could suggest a condition known as oral thrush, which is often associated with a weakened immune system but can also occur in individuals without HIV, particularly if there are other risk factors like antibiotic use or poor oral hygiene.

You also noted that you underwent an HIV test 35 days after the sexual encounter, which returned negative. This is a reassuring sign, but it's important to understand the window period for HIV testing. The HIV Ag/Ab combo test you took is quite sensitive and can detect most infections within 2 to 4 weeks after exposure. However, for conclusive results, it is generally recommended to retest at the three-month mark, as some individuals may take longer to develop detectable antibodies.

Regarding your concerns about other sexually transmitted infections (STIs), it is wise to consider testing for those as well, especially if you are experiencing ongoing symptoms. Conditions like gonorrhea, chlamydia, or syphilis can also present with symptoms that might overlap with what you are experiencing.

As for your anxiety and fear surrounding these symptoms, it is completely understandable given the circumstances. Many individuals experience heightened anxiety after potential exposure to STIs, which can exacerbate physical symptoms. It may be beneficial to speak with a healthcare provider about your mental health and consider counseling or support groups to help manage your anxiety.

In summary, while your negative HIV test is a positive sign, it is essential to follow up with another test at three months for complete reassurance. Additionally, consider getting tested for other STIs and consult with a healthcare professional about your oral symptoms and any ongoing concerns. Remember, maintaining open communication with your healthcare provider is key to addressing both your physical and mental health needs.

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