I’m a heterosexual and uncircumcised male who engaged in penetrative vaginal sex with a female sex worker. 

Ten days ago I got drunk and decided to visit a brothel due to my lack of sex life. We proceeded to engage in sexual relations and after about 10 minutes I noticed that the condom had broken, I don’t know how long it had been that way (it must have been more than 5 minutes).  I proceed to tell my partner, to which she just tried to insert my penis in again. This disturbed me as it tells me that she’s not too concerned with her overall health and might do this often. 

Once I dressed and gathered my belongings I told her that I didn’t want to be rude, but that I must ask if she has any STIs and she answered with a casually-dry “No”. 

I immediately went to the ER of a local clinic to see a doctor and I told him what happened and I was given an injection and some pills for bacterial risks; I mentioned my concerns over HIV to which he said that my risks were very low and that I should be fine, he never mentioned PEP but I did. He deemed it unnecessary so I left without a prescription. 

18 hours after my sexual encounter another doctor told me the same thing about my risk levels but said that he’d prescribe PEP for my peace of mind and I immediately took my first pill Efavirenz, emtricitabine and tenofovir. I know that this isn’t the ideal PEP, but it’s what I was given. 

What do you think my odds are about coming up as negative?

I’ve been taking my pills on time since that day and have not missed a single dose and I also feel no illness other than anxiety. 

 I’ve asked around and it seems that the brothel I visited requires the women to be tested at least once a month. 

Congratulations on your commitment to safe, condom protected sex.  Unfortunately, condoms do break about 1% of the time they are used.  I hope you will continue to use condoms regularly despite this unfortunate event.

Like the 1rst doctor that you interacted with, I would not have suggested PEP given the low risk nature of your exposure however, now that you have started it, my advice would be to complete the 30 day course that you were given.  At this time for you, the downside of PEP is the inconvenience of taking the medication, the cost, and the fact that your HIV test results will now not be conclusive until about 6 weeks after your last PEP pills (the "clock" for ruling out HIV is 6 weeks for conclusive results but does not start until you have stopped taking the PEP).

I hope this information is helpful.  Between the relatively low risk nature of your exposure and the medications you have and are taken, I am confident that you will not have an STI including HIV from the exposure you described.  EWH

 So in theory I have a 99.9 chance of coming out of this clean, without accounting for the Pep? Is it true that an acute infection would increase my risk 26 fold?

Take care.  EWH 

However, one issue that still seems to be interfering with my mental peace is the aspect of a possible acute infection. Let’s say that what she and others say is true and she gets tested once a month, than maybe she’s negative due to recent/acute infection. Furthermore, her wanting to continue with unprotected penetration implies to me that she must do this often with other customers. 

Sorry again for the bother. 

As a commercial sex worker, the likelihood that your partner had HIV is quite low (certainly less than 5%, probably less than 1%) and the likelihood that your had acute HIV is vanishingly low (far less than 1%).  Even if she did, the likelihood that you would be infected between the fact that you had a single exposure and that you took PEP is substantially less than 1%.  You can of course prove that you were not infected to yourself with testing.  A 4th generation, combination HIV antigen/antibody test will detect more than 99% of recent infections at 4 weeks after your last dose of PEP and at 6 weeks will be entirely conclusive.  If your level of anxiety is so high that you cannot wait for 4 weeks, a HIV RNA PCR test any time more than 11-12 days after your exposure would also provide strong evidence that you were not infected.

In my opinion, no matter when you test or what test you use, I anticipate that testing will should that you were not infected.

I hope this perspective is helpful.  This concludes this thread.  EWH