Worried about HIV risk

[Morethanworried]

28 days ago I had sex with a CSW from Thailand. It was penis to vagina sex with me being the one penetrating. The sex lasted about 20 min to half an hour and stupidly I stopped applying more lube towards the end. I could feel the friction but did not think the condom would break but it did.
I was thrusting very hard towards the end and am worried that my penis would have been exposed to the same friction as what caused the condom to break thereby increasing my odds of contracting an std.
I don't know how long the condom was broken for, my guess is anywhere from aboht a minute to 5, hopefully not more but I can't remember and suppose it is possible. She only noticed after I came inside her.
Her reaction put me at ease a bit at the time, she was very annoyed and told me she didn't want to catch HIV or anything from me.
I got in the shower about 5 min  afterwards and washed it with soap.
I only noticed when I got home I had a small area of skin on my foreskin that was a little raw and had a few small cuts, obviously from the friction. No blood though.
I started taking Combine about 2 and a half days later (60hrs) but it made me so sick I couldn't persist past 9 days, a decision I hope I don't regret later. About 2 days after stopping the Combivir my penis foreskin became very red and  inflamed. I was so worried and still am that it was herpes.
I went to the doctor who said it was most likely a candida infection and he gave me a once off antifungal tablet and a course of antibiotics.
I also went for a full std screen minus HIV but realize now it was still too early to test for the more serious ones.
The antifungal definitely helped but the candida, if that's what it is, took a long time to clear up.
It's 2 weeks since and still hasn't cleared 100%
About a week ago I had a few days of generally feeling a bit down and tired, admittedly I have suffered from similar symptoms before but couldn't really tell if it was just that or worse. Also had sore tendons at the back of my legs in the bend of the leg. The sore legs persisted for the entire day and in the morning and evening of the next day.
Admittedly I did go to gym at the beginning of the week and it was first time back in a while so it could maybe be from that, however usually I get gym pains from 2-4 days after gym whereas this was maybe about 5 or 6.
On the same day I woke up with a bit of a headache. It was quite mild and lasted about half an hour. That night I had only a sudden sharp but not that painful pain in my head which went away.
Since then I've had similar pains at intermitently but no constant headaches.
Today I had a weird feeling in my head like a fuzzy ball in the centre and then the same sharp pain that went away.
Haven't had any noticeable fevers but at times I've felt a bit hot and noticed that I've been sweating more than what I think I usually do.
So worried that these could be seroconversion symptoms and really been stressing out so much about it, can't stop thinking about it.
I've read that statistically my chances of not contracting it are very good but there are things that worry me such as the friction my penis was exposed to, the length of time without a condom, the candida infection and those other things I described. Also worried because she is from Asia and I've heard that the more virulent E strain is much more common there. So really worried that these things make my odds much higher.
Also wondering if hiv is supposed to be so difficult to catch from penis to vagina sex then why do so many people still contract it?
Also worried if any of those things I described sound like seroconversion symptoms, really worried about the legs and the tiredness. I didn't have much of an appetite either but still did eat although admittedly a lot less. Haven't had anything that's felt like the flu. Everytime I feel anything out of the ordinary now I begin to panic

Also when should I get tested for HIV? It's exactly 28 days today and 17 since I stopped the pep.
Will the fact that I took pep for 9 days increase my testing window?
Many thanks for any advice you can give, so worried

[Morethanworried]

Not sure why anyone isn't answering me at all but would be great to have some input.
Yesterday I went to give blood for an ELISA 4th generation test. I go back this afternoon to get the results.
Have I done this a bit early and will I need to test again.
The lab says window period is 18 to 21 days and It was 21 days after pep, 32 from incident.
Spoke to an HIV councillor yesterday and she told me that its a difficult virus to catch.
Read something that said that the 1 in 2000 risk was for the general population and not from a confirmed infected source and another site that says that those statistics are when the source is confirmed to be positive.
Don't know what to believe?

[Morethanworried]

I know I've been advised not to pay any attention to symptoms but the timing is really freaking me out.
I feel like I would be more concerned having symptoms than having none at all.
Apparently about 70 percent of people infected have seroconversion symptoms so I feel like having symptoms makes the statical chance of having HIV theoretically worse despite people saying don't worry about symptoms.
I was just wondering if the things I've experienced sound like symptoms or something else?
The red foreskin and head of my penis really worries me because it arrived 2 weeks after the incident. It was also 2 days after I stopped PEP.
Is it possible for the Combivir to have any part in that?

Another question I wanted to ask is by how much viral load affects the chance of catching the virus.
I know the chances of catching it from vaginal sex are supposed to be about 1 in 2000 but does that drop significantly if the person was recently infected and had a high viral load?
Also would the small cuts on my foreskin increase the chances too. I've heard differing opinions on that.
I've heard that fingering someone with cuts on the finger doesn't really present a risk so small cuts on the penis wouldn't make that much difference but then it does seem like an easier way for the virus to get in.
Also does health affect things much.
For eg. those one out of 2000 people, do they usually have a weak immune system already or doesn't that factor in much?
Also have heard that the number of incidences increase your chances of catching the virus. Is the number of incidences more important than the duration of the incident?
In other words would 10 encounters of 2 minutes be more risky than one encounter of 20 minutes?
I was planning to go to the lab tomorrow but am so scared.
I literally go very light headed and into a massive panic whenever I think about it which is practically all the time now.
I don't know if it would be a good idea to get the rapid finger prick test and then do the 4th gen Elisa or to just do the Elisa?
I just don't know how I'm going to contain myself enough to go back for the results. I don't even feel like I have anyone close enough that I can take with me.
Just feel like my family would be so disappointed and wouldn't understand so don't even know what I would do from there.
Sorry about the many questions but would be great to get an answer on those points.
Many thanks

[Morethanworried]

I spoke to the girl yesterday and she told me she took a test in October. She said that the test had 1 line not 2 and she was therefore fine when she tested. She says that she always uses a condom with customers but it turns out she's had unprotected sex with a boyfriend since, who had unprotected sex with a prostitute so I'm assuming his symptoms are unknown. Don't know whether to trust what she says as there is a big language barrier difference.
She seemed fairly unknowledgeable about HIV so didn't do much at all to put my mind at ease.
I'm in South Africa so the odds of someone having it here are far higher than in Europe or America.
I found a website of one of the big labs here that claims 1 in 5 people are infected in this country!
They offer the 4th generation Elisa test and say that they can give a conclusive result  from 21-28 days. Does that sound correct?
They say that they give you the result in 2 days. If I go on the 29th it will be 33 days since the incident and 22 since I stopped PEP.
Does it sound like a good idea to go on this day?
Thanks for the replies, I'm finding it helps a lot to talk about it. Have a Merry Christmas.
Unfortunately it's going to be the most worrisome Christmas for me in my life.
It's awful how one mistake can cause so much stress

[shaunw84]

Hopefully this never happens again, but if it should see if you can switch to a different ARV.   You're doctor should have given you this as an option.  There are lots of ARVs even in Asia.

You just need to be on a 3-drug ARV therapy.  The european and US recommendation is Truvada + Isentress because it is extremely well tolerated.  Truvada is available. I think Isentress is a little bit more difficult to find.

[shaunw84]

People who are not on PEP can test 28 days with a DUO test and are considered conclusive in europe.  Europeans have much more experience with the DUO test then in then US (CDC).  I think once the US has more experience with 4th gen test, 4 weeks will be conclusive here also.

Since you were on PEP 9 days, just add the 9 days to the 28 day window.  That would mean in about 2 weeks you can get a DUO test and be conclusive.  (DUO is a 4th gen Ag/Ab test).  Get the lab test not a rapid test -- even if it's 4th gen, if you can.

If she uses a condom and is worried about you, you can bet she knew she wasn't positive prior to you.  So you have that in your favor.

I'm sure you're worried, but in US where CSWs are forced to wear condoms (Nevada) and are tested regularly not one has ever tested positive.  Canada doesn't force testing, but where CSWs use condoms, in research, the prevalence of HIV is no different then the general population.

[Morethanworried]

Thanks for the replies.
Nounounabo surely that statistic is for condom use?
I've read that it's in the region of 1 in 2000 for penile-vaginal sex.
I've also read that it's as high as 1 in 30 to 1 in 50 for the E strain virus which really scares me.
I don't know how much truth there is in this.

I know that you can't diagnose the disease based on the symptoms but I keep freaking out whenever I suspect something unusual with my body.
I've read about HIV rashes and so worried about the red on my foreskin as it seems to fit that description a lot except that it would be rare to have a rash on the genitals.
There was no itching which really worries me as HIV rashes apparently don't itch.
Really hoping it was just a reaction to stopping the Combivir although I don't know if that's something that really happens.
Freaking out so much I can barely sleep and the worst is I'm almost just a month in, don't know how I will survive the next two.

Is there any point getting a test at 6 weeks, obviously I want it to be negative but it's still inconclusive at that stage so would there be a point?

[nounounabo]

Dear Morethanworried,

1- The estimated chance of catching HIV from penis to vagina is 5 per 100000 exposures. The risk will definitely be increased if you are exposed more than one time to the virus or have multiple sex partners.

2- The symptoms were never and will never give you a diagnosis for HIV, only testing will give you an answer.

3- the CDC guidelines for HIV testing is 6 weeks after exposure as a primary test and for conclusive test after 90 days.

4-  It is always recommended to test 90 days after the PEP.

[Vance2335]

28 days after PEP you can have a DUO test or an antibody test 8 weeks after PEP was stopped.

[Morethanworried]

Also wanted to add that I thought it strange that the candida infection only appeared 2 weeks after the act, seemed to be in exactly the front part of the foreskin that had been left a bit raw. I've had candida infections before but never one as bad as this or that lasted so long. Could it be a result of my immune system being a bit suppressed from the Combivir?