I showered first. She put a condom on me and performed oral sex. We moved to vaginal sex and I noticed the condom broke (felt it). I withdrew and put a new condom on, and we continued. I’d say there was no more than 3-4 minutes of unprotected exposure. We both showered again after finishing. She told me she does not have any STDs and is offering to test, but has also asked me to test as well so we both have proof.

I panicked and visited a doctor. Doctor prescribed me PEP (Tivicay and Truvada) along with doxycycline. I took both around 50 hours after the encounter. It is now about 75-78 hours after the counter and I’m awaiting STD test results.

What is the risk of me getting HIV and other STDs?

You went about this event with maximum safety by intent, and it remained quite safe despite the condom failure. At the prices you describe, I would consider your partner an escort -- by which I generally mean expensive female sex workers by appointment. In the US, most such persons typically know the score, care about their health, use condoms consistently, get tested often, and in general have low risk male clients (men like you). Therefore it is generally believed that at any point in time, few have transmissible STDs. And don't forget that even without condom protection, most STDs are not efficiently transmitted -- that is, most exposures don't result in transmission. Considering all these factors, the likelihood you acquired any STD is low, even with 3-4 minutes of unprotected vaginal sex.

I'm also very pleased to hear your partner has offered to be tested. I hope you and she are doing that.

I'm quite surprised the doctor you saw prescribed PEP; with no more evidence your partner has HIV, I would have advised against it. The likelihood your massage/escort partner has HIV probably is no more than one chance in a thousand. On the other hand, probably no big deal, if your partner goes ahead with testing as planned. As soon as you know she has tested negative for HIV, you could safely stop the PEP. (You and your doctor may not have considered the effect of PEP on sometimes prolonging uncertainty and anxiety. With PEP, the clock on reliable HIV testing -- in case PEP doesn't work -- starts with the last dose of PEP. Completing the prescribed 4 week regimen means not having a reliable test result until 6 weeks after the last dose, i.e. 10 weeks after exposure -- and some experts advise even longer, to 3 months after the last dose.)

All in all, I would say there is some risk (probably quite small) for gonorrhea and chlamydia and nearly zero risk for HIV and syphilis. Taking doxycycline is effective prevention of chlamydia and syphilis, so if you complete 7 days treatment those risks will be zero and will not need testing. The doxy reduced your risk of gonorrhea by about half. That was quite low risk to begin with. 

And I would disregard any risk for any other infections and wouldn't test for anything else. But let me know if you have any particular concerns about others, such as herpes, HPV, hepatitis B, etc. I do not recommend testing for them.

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

HHH, MD

Thank you for your reply! I do feel a bit better based on your responses. I have more questions and additional information.

The encounter was on 7/10 and I took a 10-panel STD test on 7/13. All the results are negative, but chlamydia and gonorrhea results are still pending. If the results for chlamydia and gonorrhea are negative, is this conclusive or do I need to retest?

I was only prescribed one 200mg tablet of doxycycline to take within 72 hours of the exposure, not a 7 day treatment. How does that change the risk? Exposed 7/10 and took it on 7/12.

The doctor prescribed PEP to be “safe rather than sorry” — assuming my partner tests negative for HIV, I understand I can stop taking PEP, but what harm is there if I continue to finish the 30 day treatment?

My partner said she is getting tested today, so I’m hoping that her test results (and mine) are all negative. She seems to be less worried than I am and thinks we are fine. However, she “thinks” she has a yeast infection and her pH levels might be off. Obviously, this raised my anxiety a bit.

In some ways I feel better, but still have anxiety until both of our test results come back all negative

Thanks for the additional information.

I've already described the possible harm in taking HIV PEP -- prolongation of the time until you know you were not infected. If your partner tests HIV negative, I don't know why you would want to consider continuing treatment. However, I'm not specifically recommending that:  once someone is on a physician's prescribed treatment for anything, our uniform advice is to check with that doctor before changing or stopping treatment. But I imagine your doctor would approve stopping the HIV drugs if your partner tests negative.

Vaginal yeast infections say nothing at all about STD/HIV risk. All women normally carry yeast in the vagina and almost all have symptoms of it from time to time. It means nothing in this context. That your partner was not only willing to be tested but probably just as worried as you are is a sign of her low risk and intent to stay HIV free. After all, in the long run sex workers are at far higher risk of HIV from male partners than those men are from them.  You should be reassured that she cares!

Thank you for all of your help!

Just wanted to give another update.

The chlamydia and gonorrhea results came back negative as part of the 10-panel test (exposed 7/10 and tested 7/13). All my tests were negative except for HSV-1 since I’ve had as a kid (I had one cold sore as a child and never had another). I know you mentioned not to test for it, but it was just included as part of the test package.

I shared my results with the massage therapist/SW. She told me her test results were negative, but would not show proof. She pointed out that I have HSV-1 and am responsible for cold sores that she got two weeks after the encounter.

I did not kiss her on the mouth and my mouth did not come into contact with her vagina. My mouth only came into contact with her breasts and nipples.

Her mouth came into contact with my testicles, but she used a condom for oral sex (penis in mouth).

Could the broken condom exposure have resulted in her contracting oral HSV-1? Or could she have contracted it from my testicles even though our mouths never came into direct contact?

Thank you tons for all of your help

I'm glad to hear of your negative test results, but of course not surprised.

You'll understand we cannot get into legal advice. But I really don't think you have anything to worry about in regard to her accusation.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.