My question is - does this seem like a rational course of action or am I over reacting? I’ll be doing all of the tests and stop seeing sex workers. But I’m honestly a little conflicted about PEP. I know it can be tough on your body. I’m honestly not sure if the condom came off or not which is enough to give me pause around PEP.

I'm not sure I fully understand the situation, but it sounds to me like your penis slipped out of the condom as you withdrew from your partner's vagina. If so, protection was complete against HIV and STDs. I would not advise PEP. Most likely your partner doesn't have HIV; and even if she does, it sounds like protection was complete. PEP usually isn't given unless the risk of HIV is a lot higher than this.

That said, with currently recommended drugs, PEP isn't "tough" on the body. Still, the risk is too low. In fact, even testing for HIV and other STDs is optional. Probably you should be tested for reassurance -- but that's all; and you can expect negative test results.

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

HHH, MD

OTOH, nobody can say the risk is zero. You'll have to make your own judgment about whether to get tested, seek PEP, or both. Alternatively, if you are able to communicate with your partner, perhaps she would be willing to be tested for common STDs (gonorrhea, chlamydia, syphilis, HIV) -- at your expense. If negative, you'll know for sure you weren't at risk.