1. Should I be more worried about getting HIV since I had sex when I had an outbreak?

2. Does this also increase the chance for other STI (syphilis, chlamydia, and gonorrhea)?

3. I've noticed I seem to get outbreaks after having sex. Does the rubbing during sex increase the chances of a herpes outbreak?

You don't say where you are, but in most countries, under 1% of female CSWs have HIV. so it is statistically unlikely your partner is infected. Second, even without condoms, the average transmission risk from a single episode of unprotected vaginal sex is around one chance in 2,500. Having genital herpes due to HSV2 roughly doubles that risk -- still only one chance in a thousand, and that's only if the female has confirmed HIV infection. There has never been a proved case of HIV transmitted mouth to penis, so the oral sex part of your exposure can be disregarded entirely.

Those comments pretty well cover questions 1 and 2, but to be explicit:  1) Little or no risk of HIV for the reasons just stated. 2) There are no data to suggest that herpes raises the risk of other STIs. The condom for vaginal sex was the most important prevention aspect, and pretty much protected you from everything. The unprotected oral sex was somewhat higher risk for gonorrhea, maybe syphilis, but extremely low if any risk for chlamydia.

Turning to your herpes story, I'm inclined to doubt you have it -- or at least that it's the cause of the "outbreaks" you describe. The answer to question 3 is a definite no:  sex, rubbing, or other irritation of the genitals definitely does not trigger herpes outbreaks. That alone makes it extremely unlikely that your  "outbreaks" are herpes. Have you seen a health professional about this? Has herpes been diagnosed -- and most important, confirmed by lab tests? Do some of those episodes progress to blisters or open sores? If so, how long does it take until they heal? How often do these episodes occur? I'll be happy to go into this in more detail if you'd like to address these questions.

In the meantime, I wouldn't worry about HIV or other STDs on account of this event. Of course you're free to get tested anyway, but it's optional.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

To answer some of your questions. I've had these outbreaks for a few years now. I have no idea where I got it from. I have seen my family physician about this and they confirmed it was herpes. He confirmed after looking at it and from my descriptions of the outbreak. We never did any tests. I typically get 3 or 5 outbreaks a year. They always progress to blisters or open sores. It usually takes a week to two weeks from initial onset to being healed. 

Three to 5 outbreaks per year is typical for genital HSV2, so that fits. So does the duration of each outbreak. And if your doctor is experienced in diagnosing and caring for patients with genital herpes, his opinion is important. However, most herpes and STI experts advise not relying solely on symptoms and exam for the diagnosis -- i.e. laboratory confirmation is advised. There are different attitudes on this among some in Canada. However, I would advise discussing with your doctor and arranging for being seen promptly (within 2-3 days) after onset of your next outbreak to have a PCR test to identify the virus.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful. If you do decide to be tested on account of the exposure you have described, I would advise only urine for gonorrhea/chlamydia and, after a few weeks, blood tests for HIV and syphilis. You also could take this opportunity to have a type-specific HSV blood test, with a good chance you would test positive for HSV2. But if you have a typical "comprehensive" STI test panel, ignore results for Mycoplasma hominis, Ureaplasma, and blood test results other than HSV, HIV and syphilis.

I hope the discussion has been helpful.