On Nov 5 I had an exposure with an escort that has be concerned. She proceeded to insert the tip of my penis in her for about 5-10 seconds before I told her I didn't feel safe and prefer a condom. We have used condoms in the past and this would have been my 3rd time seeing here. I'm thinking she felt comfortable with me and that's why she tried to do it. This occurred in Sao Paulo Brazil where I read that HIV is quite common. My concern is should I go to a DR to get pep to minimize the risk of getting HIV?

Given the exposure was so short not sure if that increases the risk or reduces the risk since it was unprotected for a short time. I appreciate your advice. I plan on getting tested in 4 days and again in 30 days. What do you reccomend?

"Escort" usually means an expensive female sex worker by appointment. If this describes your partner, she probably knows the risks, tends to have partners at relatively low risk (men like you), usually uses condoms, and gets tested frequently. That she didn't initially use a condom for your recent contact probably indeed reflects her accurate judgment that you're a low risk client. Does it increase the chance she does this often and might be at somewhat higher risk of having HIV or other STI? Maybe, but probably not much. 

Further, your own assessment that such a short exposure lowers the risk undoubtedly is accurate. There are no data on this, but I would guess this still was essentially a zero risk event even if she has HIV, and almost zero for other STIs. And remember that even with unprotected vaginal sex to completion (a few minutes), the average transmission risk -- if the female partner has HIV -- is about one chance in 2,500.

Should you be tested? As I said above, I really do not consider it necessary -- but of course you are free to do so if you would gain additional confidence from the expected negative results. If so, the only tests valid at 4 days are urethral swab or urine for gonorrhea and chlamydia. (Blood tests for HIV and syphilis would serve only as a baseline to show you were not infected prior to this event.) Thirty days is a bit early:  wait until 6 weeks after the event. (Thirty days would detect 95-98% of these infections, but 6 weeks is suggested for 100% certainty).

Another option is to discuss your concerns with your partner, and for both of you to be tested for gonorrhea, chlamydia, HIV and syphilis. If all results are negative, both of you will know there was no risk and there would be no need for testing in a few weeks.

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

HHH, MD