I am 35m with no history of STD. I recently went to a SW in California. I did get oral without condom for erection and after that put on a condom and she was on top of me. I am not 100% sure if the condom broke but quite sure it was in tact. (This is the unsure part). She did clean with alcohol wipes. I did not give any oral nor fingered her. After that there was another session of just hand job with lube. I am uncircumcised . Due to the anxiety of contracting HIV I connected with express care and substitute primary care as well (my primary care doc was on leave) and they told me the risk of pep(liver damage) and said this could be a high risk environment (although after 2 days I don't feel it was a high risk environment) and suggested I start pep. There was no time to get the base line for kidney and liver done. 

So I started pep two days ago around 19hrs after exposure. Today would be my 3rd day. After reading about the side effects of PEP I am now even more concerned about continuing. I read few posts of yours and I feel now that mine was no risk at all. Should I continue the pep or is it okay that I stop it now? I do understand other STD risks I will definitely get tested around 14 days. But I genuinely feel I will be fine with the odds. But there is definitely one thought which says better not to be sorry later. But would it cost my liver and kidney? I do take levythyroxine. 

Seeking help on this regard. 

This was a less risky exposure than you might think. Oral sex is quite safe, even unprotected -- the chance of HIV is zero for all practical purposes, and the risk of other STDs also is much lower than for unprotected vaginal or anal sex. Almost certainly you would have been aware if the condom had broken. I'm a bit surprised your doctors (two of them, apparently?) advised PEP in this situation. The chance any particular female sex worker has HIV (in the US) is under one percent; and a single episode of unprotected vaginal sex has around one chance in 2500 of transmission to a male partner; and you used a condom. 

That said, PEP is safer than you seem to think. The chance of significant health problems -- liver, kidney, or anything else -- is very low. And your thyroid drug makes no difference. However, there is another downside to PEP that you and your doctors probably didn't consider. Without PEP, you could have nearly conclusive testing for HIV in about 2 weeks (with an HIV PCR/RNA test) and conclusive results with an AgAb (4th generation) blood test in a month. With PEP, the clock on testing starts with the last dose of drug, i.e. 4 weeks from now -- so you'll be uncertain about the final outcome quite a bit longer. Are you prepared to wait that long to know for sure you weren't infected? I'm not advising that you stop PEP -- but you might discuss this aspect with your doctor(s).

As for other STDs, you don't need to wait 2 weeks. A conclusive urine test for gonorrhea and chlamydia can be done now; and two weeks is too soon for either HIV testing (especially while on PEP) or a syphilis blood test.

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

HHH, MD

Yes an express care PA and a sub primary care  both said unknown status of the SW makes it high risk. 

I have a second consultation today with another primary care doctor to continue the medication or not. 

However would stopping PEP cause any problems? The nausea is bad. Express care PA specifically mentioned it's not a benign drug and affects the liver.  Tenofovir, tivicay dolutegravir is what I got. 

I have a lab appointment for std panel. But I am concerned about HIV contractions. May be it was my anxiety  and guilt which made me connect to express care and primary care and probably to ease of my mind they prescribed PEP. But now after calming down I feel I just need a full panel test earliest 2 weeks. 

Thanks again for responding. 

Wondering what happens if I stop after 3 days of PEP except for the delay in testing. 

Nobody needs a "full panel" of STD tests. All you should have are gonorrhea/chlamydia (urine) and syphilis and HIV blood tests. All other tests in "comprehensive" panels are poor tests whose results are not always reliable (e.g. HSV) or for infections with such low risk that it's a waste of money and time. In any case, no blood tests are useful at 2 weeks, as discussed above; and you don't need to wait that long for the gon/chl urine test.

These replies are very  helpful. 

Thanks for the thanks. I'm glad to have helped. That concludes this thread. Best wishes and stay safe.