HIV/STD risk

[Kingoflimbs]

On December 19th I met with a sex worker in Dallas. She performed unprotected oral sex and protected vaginal sex. The oral was limited to a maximum of two minutes. She then gave me a condom which I put on and we performed protected vaginal sex. I was nervous about the situation to begin with so the sex was very slow and lasted again maybe 2 to 3 minutes. She did not seem to be very wet at all. I came inside her (with condom still on), pulled out, removed condom. It did not appear to be broken and there wasnt any sign of blood on the outside of condom. I arrived home about an hour later and showered.
Would this be described as a low or no risk situation? Regardless I plan on going to get a DUO HIV test and a full STD screening. It has been 24 days today since possible exposure. Would you recommend testing at all? I was thinking about going to get the DUO today but was unsure if I should just wait till Monday, which would be 28 days.
My anxiety and stress levels have been unbelievable as I have been in a relationship for a few years now and we have a son together. I have made a mistake that I will never make again.
Also this weekend (roughly 18 days after exposure) I developed a single raised hard red lump in my pubic hair. More towards the top left center of my pubic region. It stayed generally the same until this morning when I looked it appears to be starting to scab a little and appears to have a black center. Is this a cause for concern? It hasnt yet broken open and I have not popped or picked at it.
I have crawled all around these forums and they have offered me a little ease but Im still extremely worried, losing sleep and appetite due to anxiety.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to provide a perspective on this exposure.  Your description was quite complete and I would categorize this exposure as NO risk for HIV or for other STDs.  Most commercial sex workers do not have HIV (or other STDs) and among CSWs, your partner was less likely to be infected than most, based on your descriptions.  Even more importantly, your exposure was condom protected and your condom remained intact throughout the exposure (when condoms fail, they break wide open leaving no doubt that they have failed) making this a no risk exposure even in the very unlikely situation that she had HIV.  The only reason for you to test for HIV related to this exposure is for your peace of mind.

If you choose to test, please wait until Monday (28 days).   At that time your test results will be conclusive and since you are doing this for self-assurance, you shoul test when the test can provide the most reliable result possible.

Finally, the red bump you describe sounds like folliculitis ( a "hair bump"), not an STD. Please do not pick, scratch or scrape it.  Hot compresses may help it to come to a head at which time it will burst and go away.  

I hope my comments are helpful to you.  EWH

[Edward W Hook, MD]

DUO tests are a combined p24 antigen and HIV antibody test.  A p24 antigen test alone would be insufficient but both tests seperately would be the same as a DUO..

Time for this thread to end.  Take care. EWH

[Kingoflimbs]

Sorry I did find the post. Was on my phone and it was not showing the full page. The clinic I talked to offers the p24 and antibody tests seperately. Would just the p24 test be accurate or would I need both?

[Kingoflimbs]

Hmm came to reread your last post but can't seem to find it now. Was there a change in your recommendation for testing?

[Edward W Hook, MD]

DUO tests are sometimes hard to find.  If you get a PCR for HIV and a standard antibody test (rapid or otehrwise) the results will be equivalent to what a DUO could provide and would be definitve.  An antibody test without a PCR at 28 days will detect agbout 90% of recently acquired infections at 28 days.  Whenever you test, I anticipate that your results will be negative, as I have said before.  EWH

[Kingoflimbs]

Hello again Doctor. Today is 28 days since my possible exposure. My plan was to go get a DUO test but I'm having trouble finding a lab that offers it (most of the receptionists I've talked to don't even know what it is.)  At 28 days if I got a rapid test could I trust the results to be accurate? Also the anxiety and stress has started to greatly affect my personal life so quick results would definitely be a bonus as long as I could trust them to be accurate.

[Edward W Hook, MD]

Yes, I ahve seen persons acquire HIV after a single episode of unprotected vaginal intercourse but only once or twice.  it is a very rare occurrence.  Please don't worry.  EWH

[Kingoflimbs]

Hello again Doctor. While your responses made me feel more reassured, once I woke up this morning all my fears and anxieties are back. For my reassurance and anyone else who comes across this post in the future could you answer a question for me?
Have you or Dr. HHH ever seen a case of HIV that was acquired through protected vaginal sex?
Out of curiousity, what about single exposure to unprotected vaginal sex?

[Edward W Hook, MD]

Glad we could help.  I am confident that when you test your test will be negative.  EWH

[Kingoflimbs]

Thank you again Dr. Hook. I hope you realize what a valuable service you and HHH offer here. With so much overly cautious and misinformation on the internet it is good there is somewhere to turn to for trustworthy and fast answers. Instead of crawling in a hole (was seriously considering checking myself into a mental health or rest center until I got accurate test results) I will try to get through these next few stressful days and test on Tuesday (due to MLK Day) feeling more assured of getting negative results and being able to trust the results when I do get them. On behalf of myself and everyone else who has posted on here I cannot thank you enough.

[Edward W Hook, MD]

The no risk statement pertains to HIV.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  

Oral sex is a low risk activity for STDs, both because oral infections are uncommon an becuase the process is not biologically efficient.  With unprotected oral sex there is a very small risk of getting NGU or gonorrhea.  Both problems however are typically symptomatic at between 3 an 7 days following exposure.  

Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, your exposure was brief; I would urge you not to worry. If you must, you could go to your local STD clinic or health care provider to be tested at this time.  The tests will be negative and in my opinion, you do not need testing at all.  EWH

[Kingoflimbs]

Thank you for your quick and professional response Dr. Hook. I do not mean to question your answer in any way but I would like to reiterate a point for clarification. Even with the unprotected oral sex I would still fall into the NO RISK category for both HIV and STDs? If you wouldn't mind explaining the no risk aspect for the unproteced oral for me it would greatly ease my mind in this very difficult and stressful part of my life.

[Kingoflimbs]

I should also note the girl was not a street walker. She is a white 26 year old who charges around 300 dollars an hour. I found her on a site that requires a username and password t access. The site also offers reviews on the girls from previous visitors that show prices and activities she performs. From all the reviews on her she always uses a condom but does offer anal (which I did not do). She normally does not accept african americans but sometimes does perform visits with another girl on the site, who is 21 and white.