I'll try to be brief and to the point. Today I went to massage parlour but it was a scam. The doors opens and the girl was hiding behind it and it wasn't the girl on the picture. Anyway, while trying to escape I pushed her aggressively but she defended her self and scratched me 2 scratches that I found later 1 in my neck and one in my forearm. They didnt bleed but they were reddish, her defensive move lasted 1 second, but after that move I saw her taking or putting (not sure) something in her pocket like an object but not sure what it was. 

Risk if it was with her nails? If it was with a cutting object? And the worst scenario if she scratched me with a needle? Is it possible to get the scratched I described from a needle? To me they look like from nails or im just lying to my self...

The girl really looked like a drug abuser and had scars everywhere. I don't want to mention her country or race but they were scammers. 

Do I need to test? Is a combo at 28 days conclusive? Please take into consideration the worst possible scenarios and details I mentioned. 

Thank you

Sorry to hear about these obviously upsetting events. But I really think you have nothing to worry about in regard to HIV. Statistically, it is unlikely a soman like this has HIV. Certainly I have no way to know with certainty, but the odds are on your side. Second, nobody has ever been known to be infected by being scratched or bitten by an HIV infected person. Standard prevention advice often suggests this sort of thing could be risky, but that's based entirely on theoretical considerations, and as far as we know it hasn't occurred. If you think about it, it doesn't make much sense:  she would have to be infected, to have a particularly high amount of virus in her blood, and her nails would have to have enough blood on them to be dripping wet. Third, when skin wounds have resulted in HIV, they always were in medical settings and involved sharp instruments wet with visible blood. Finally, my guess is that your scratch wounds look just like that, scratches -- i.e. not a slash with a sharp instrument. I can't say whether or not she had some sort of metal object that she quickly stashed in her pocket -- but even if she did, I see no significant risk of HIV in this situation.

Having said that, you certainly could be tested if you feel it necessary. I do not suggest it from a medical or risk standpoint, and if I were in your situation, I would not feel a need to be tested. On the other hand, I understand that anxious people in your situation often are more reassured by negative testing than by profssional opinion, not matter how expert, reasoned, and science based. So if you're going to find yourself worried despite my words, by all means fell free to get tested.

The HIV antigen-antibody ("combo", "4th generation") blood tests are almost conculsive (98-99%) at 4 weeks, but require 6 weeks for 100% conclusive results.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

I try to understand the medical information and be confident, but I won't lie I have been suffering from fear of dieases and all kind of things such as strokes heart attack herpes etc... That my life became such a nightmare. just a few points to clarify please, let's assume that lady was a drug abuser and HIV pos, which I believe because of many reasons I can't mention, you still think if she scratched me with nails or razor it's not a risk? Theorically could my scratches ( still reddish after 14 hours and about 5 mm  long) come from a needle ( the object she took) or a needle would make like a point? If it was a needle stick is the risk higher?

Last question doctor: I have had a few days back with a trans sex worker an encounter, I gave annalingus for about 10 seconds, received also for 10 sec, protected oral both, licking testicles both, liclomg around the anus area for a few minutes just the buttocks not the anus and finally some kissing , nipples sucking and frottage? Is this a risk for HIV and other STDs like herpes and syphilis? Thank you so much

The sexual encounter you describe also was no risk for HIV, and also no risk for other STDs, including herpes and syphilis. Congratulations for having entirely safe sex.

The tone of your questions indicates you are under a lot of stress and are very anxious. You seem to be very unhappy with your lifestyle and I suspect you are at least abnormally anxious and maybe seriously depressed. Please consider professional counseling, which I suggest from compassion, not criticism.

Finally, as I said above, even though you are at no risk for HIV (or STDs) from the events described, I think you should be tested for HIV and perhaps also for syphilis. Do it ater 6 weeks have passed after both events. I suggest this not because you are at risk (I have explained why you are not), but because you probably will find the negative results more reassuring than my professional advice -- that's often the case with persons having anxiety problems.

Also, I woke up this morning and the scratch on my throat is more visible reddish and dry now and you can a line of about 1cm. 

My main concern is if I got a needle stick? How risky?  Her whole move was fast about a second as it was defensive, I'm just trying to not miss any details for risk assessment. Thank you for your support.

That completes the two follow-up questions and replies included with eacht thread and so ends this discussion. Do your best to move on without worry. If you remain anxioius about all this, first carefully re-read all my comments above; and second, feel free to be tested in a few weeks for firm evidence you weren't infected. But stay mellow in the meantime. There's no realistic chance you were infected.