bali/singapore risk

[worrywar88]

Hi Dr,
I have a few questions and need your expert opinion. I was in Bali on holiday and had two risky encounters. First was a broken condom Jan 7, I withdrew immediately and changed. Second was Jan 9 and I had one maybe two sessions of unprotected sex. Both girls were CSW and I am uncircumcised. Jan 19 I had a duo hiv test and came up negative (in Australia/Sydney). Jan 24-25 I was in Singapore and had two unprotected vaginal sessions with a CSW. I haven't had sex since and am scared to test. What is my approximate risk? Any estimation might help me get the courage to go test so I can continue having sex again (protected of course - have stopped binge drinking). When I got back home from holiday I noticed I had small white bumps underside of my foreskin. Dr diagnosed HPV. I have been trying to treat (with condylox) but they keep recurring and I'm concerned i am getting scarring/discolouration. Any advice on how to clear the virus with other means? I am a smoker and drink too much alcohol. Finally, am I able to start having condom protected vaginal sex and receive unprotected oral given my HPV diagnosis? I don't want to pass it to anyone and am very shy to reveal. Thanks in advance and regards. I've looked at other questions and you guys do a good thing here..

[Edward W Hook, MD]

I'm sure there is some value to a DUO at 10 days but I am not sure what it is.  There are no data.

Transmission of HPV (not that is what you have) is not something that we deal with much here .  PRetty much everyon who has been sexually active will have HPV at some time.  Further, as i aid earlier, I suspect you d onot have warts.  EWH

[worrywar88]

Thanks dr. Is the negative test 10 days after second bali encounter meaningful? Duo at 10 days accuracy? If so id be retesting for the 2 x (same girl) in singapore. Presuming it is hpv can I pass on via condom protected sex? The bumps are under my foreskin so wouldn't come into direct contact while wearing a condom. What about oral? Would a girl giving me a bj catch hpv orally? Thanks for your time, I'll make an appt to test nexg week

[Edward W Hook, MD]

Welcome to the Forum.  I'll be glad to comment and make a suggestion or two.  

First, your risk for HIV from any single exposure to a commercial sex worker is low. Most CSWs do not have HIV and even if they do, most exposures do not lead to infection.  Following exposure to a partner with HIV, the risk of unprotected vaginal sex is less than 1 HIV infection for 1000 exposures.  Thus, even if all five of the exposures you mention were to HIV infected partners (almost certainly not), your risk for HIV would still be less than 1/2 of 1%.  That said, you need to be tested for HIV and a DUO test at this time will provide conclusive results.  Fear of testing does not do you any good since not testing will not change the result, it would only give you either the relief of knowing you were not infected (the most likely outcome) or give you the chance to seek treatment.  Go get tested so you can move forward. (while you are at it, I suggest you get tested for other, far more common STIS such as chlamydia as well)

As for your "warts", they may not be, particularly if they are not responding to condylox.  Some doctors mistake other, non-HPV processes for warts and they set out to treat things that do not need treatment.  If these are warts, they were not acquired in Bali- it typically takes six months, on average for warts to appear after contact.

I hope these comments are helpful.  It sounds to me as though you should see another doctor.  EWH