Hello doctors, Thank you for your time in reading my question and for the great service that you provide. I am requesting an assessment or possibly reassurance for a possible exposure. I have read the forum and seen several similar responses, but I believe that I just need to hear it about myself. Nine days ago I visited a CSW possibly in her 50s, at an Asian massage establishment. The provider was a female that I have seen before each time. Normally we will engage in apposition and on occasion protected vaginal intercourse. My visits aren't frequent, rough 5x per year for the past year. She was very careful regarding protection, but the last two visits she offered unprotected intercourse because she said that I seemed safe. I had declined out of fear of risk, but we had built a good rapport to include her giving me her phone number. This last time that I saw her we were engaging in apposition and when I began to climax I had trusted up at the time that she grinded down and I entered her and climaxed inside her. She didn't not seemed concerned, she appeared to enjoy and remained in place until my orgasm concluded. I was not fully inside of her, maybe three inches or so and for no longer than it would take for ejaculation to happen. Realistically maybe a minute? Minute and a half? I became worried and she advised that she had been tested 2 days prior and that she was fine and that she only engages in unprotected encounters with people that she feels safe with and that she tests regularly. The establishment is lower volume and price range around $200.00 per hour. Realistically, with such a brief exposure, how likely is it that I would have contracted a STI or HIV? My only symptom at this time is a slight soreness on the right side of my neck that I believe to be an inner ear infection due to weather. Reading posts here I decided to forego PEP. I am in the midwest US, and not in a major metropolitan area. Thank you in advance for your assistance.

You describe a partner likely at very low risk for STIs and especially for HIV, despite her CSW work. Her age is one of several factors:  even among the most sexually active people, active/transmissible STIs decline dramatically in frequency after age 30-35. And like many responsible CSWs, she is tested frequently. I think your risk for any infection from the events described is extremely low -- sufficiently low that I do not recommend testing, and certainly agree with not seeking PEP. Assuming you continue to have similar experiences with this partner, rather than worrying about individual exposures, I would suggest you plan on regular STD/HIV testing, perhaps once every 6 to 12 months. Such testing need only be urine for gonorrhea/chlamydia and blood tests for HIV and syphilis. (Don't get sucked into many labs "comprehensive" STI test panels, which cost a lot and include many tests that simply should not be done in such circumstances).

Your current symptoms don't concern me at all in regard to HIV or other STIs.

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

HHH, MD

As a follow up question, you state that you would not recommend testing in regards to my situation, which is ideal for me considering the demands of my career and the logistics involved. Would you also consider me to be in a safe situation to resume unprotected intercourse with my long time partner? She is the only person that I have engaged in any kind of intentionally unprotected activities with for well over a decade and I would like to resume. In addition to no actual ars symptoms that I can decipher I also do not have any urinary symptoms, no discharge or issues with painful urination. 

Once again, thank you so much for your insight, expertise, and perspective.