There's been so much online buzz about oral sex and STIs recently, on places like reddit's STI discussion site. It's easy to gain a very inaccurate impression of risks. In fact, oral sex is very safe, with low risks for all STIs and especially HIV. Which is why most experts do not usually even recommend condoms (and certainly not dental dams), even while strongly advising their use for vaginal or anal sex.

The bottom line is that you are at little or no risk for HIV. Several years ago, CDC calculated the risk associated with various sexual practices, based on how HIV positive people thought they had been infected (which often was wrong anyway). The estimate for penis to oral transmission by fellatio (with ejaculation in the mouth) -- if the penile partner had untreated HIV -- was one in 10,000. That's equivalent giving BJs to infected men once daily for 27 years before being infected would be likely. And if we guess there's a 1% chance your partner has HIV and isn't on treatment, your risk of infection becomes one in a million (1/10,000 x 1/100 = 1/1,000,000).

As for your symptoms, they really don't fit with acute retroviral syndrome (ARS, i.e. new HIV infection). Almost certainly you caught a garden variety respiratory virus, or maybe a springtime allergy.

"Should I be concerned?" No, not really -- certainly not seriously concerned. You might wish to consider moving up your yearly HIV test for reassurance, but not because of the risk level itself. (By the way, good strategy to be tested on a regular basis rather than running off for a new test after every new sexual experience.) Or if you are able to contact your partner from two weeks ago, perhaps he would reassure you about recent test results or other evidence he isn't infected or infectious. (And by the way, consider adding another step to your safe sex routine:  mutually discuss HIV status before proceeding. Most people are truthful when asked directly.)

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

HHH, MD

Should I have went to the ER for PEP or is that something that is only given with more high risk sexual activities?

What symptoms should I look out for if I were to have recently acquired HIV? (I know based on other thread answers I shouldn’t rely on just symptoms, but if any were to appear what would they consist of?)

I do usually ask partners about their status and he assured me that he was clean. But since the sore throat and hoarse voice came about I got concerned that maybe I caught something. 

Technically, you could have an RNA/PCR test now, but with that low a risk, consider the downside. Without PEP, you can have a second (conclusive) 4th generation blood test 2 weeks from now. If you take PEP, it will be 6 weeks after your last dose --i.e. 2.5 months from now. I doubt you want to wait that long! If somehow I were in your situation, I wouldn't even be tested, let along take PEP! And would be continuing unprotected sex with my wife with no worry at all about infecting her.