I really wouldn't be worried about these events, especially in regard to HIV, for which there was little if any risk. Based on your description, it seems unlikely your partner has HIV; and even if she does, I would consider this a very close to zero risk event. If condom failure "at the top" means the rim and upper area covering your penile shaft, there definitely was little or no risk; as long as the head of the penis and urethral head are covered, condom protection is considered complete. The brevity of exposure after the breakage also suggests low risk. And even with entirely unprotected vaginal sex for several minutes to completion, the average risk for the male partner of an HIV infected woman is estimated (by CDC) at one in 2,500.

As for oral sex, that's truly zero risk or nearly so:  there has never been a generally accepted, scientifically confirmed case of HIV transmitted oral to penis. Based on how some people believe they were infected -- which often is wrong -- CDC's calculation is one in 20,000. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. In other words, zero for all practical purposes.

Although HIV is your main concern, you are at greater risk for other STDs, in particular gonorrhea from the oral exposure, and herpes and syphilis from the partial condom failure. Absence of symptoms in the next few days (for gonorrhea or herpes) and 2-3 weeks for syphilis will be good but not absolute reassurance. So you might want to consider a urine gonorrhea test (valid any time more than 2-3 days after exposure) and perhaps a syphilis blood test in a few weeks. And since you're concerned about HIV, probably you should have an HIV AgAb (4th generation) blood test after 6 weeks, although your risk is so low that I would consider this optional. In the meantime, stay mellow:  you are at very low risk for any of these infections.

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

HHH, MD

If you're sufficiently worried about HIV that you're considering PEP, you're in a difficult ethical position about sex with your partner. How would you feel if you were in her position and later learned you were so concerned about having HIV that you were in treatment or even considering PEP? And didn't tell her? Even with condoms, that would be a dicey situation, don't you think? Don't get me wrong: I think there is no chance you have HIV. However, you could have another STD; you might have your gonorrhea/chlamydia test result by this weekend, but won't know for sure about syphilis (or HIV) for a few more weeks. The chances are low but not zero.

6-7 days is early for HIV RNA testing. A negative result would be no more than 50% reliable. This also is something to discuss with your personal HIV provider if see someone to discuss PEP.

Thank you again Doctor.  Your doing a great service doing what you do.