Thank you very much for years of service in educating us.

I have been in a long term monogamous relationship but after it ended a few months ago I had an experience yesterday that is causing extreme anxiety.

I had intercourse with another man that is apparently a CSW. It included oral and anal sex both receiving and giving. It was protected with condoms throughout and the condoms were intact. There were no other physical contact or exchange of kisses as I was very nervous. I didn't even touch their genitals with my bare hands. A couple minor details we changed condoms a couple times between anal and oral. I didn't notice if they flipped the condom but it was applied correctly both of us covering completely. Ejaculation inside condom after pulled out. He said he never does anything without a condom ever.

1) for any STD how worried should I be what would you say about the risks if condom wasn't flipped?

2) coming out of a relationship I am worried about how my anxiety will ever go away any advice?

3) assuming the condom touched for a second but he realized wrong side and it was flipped what is the risk levels then?

4) testing needed, recommended or good to do regardless of the experience? I am planning to get tested regardless but does this necessitate it more?

There is always a risk for STIs which are a function of how many partners you have and who those partners are.  Of course multiple casual partners increase risk. Despite that, it is important to remember that most people, even CSWs do NOT have STIs, and most single exposures do not result in transmission even if a partner is infected .  With new or casual partners, it is a good idea to ask them about their status, when they were last checked and among partners who may be at higher risk in your judgement, whether or not that are taking HIV PrEP for prevention of infection.  Condoms remain an important part of risk reduction in terms of HIV and other STIs.  Consistent condom use will virtually eliminate your risk for HIV, gonorrhea and chlamydia and will reduce your risk of syphilis by over 60%. Condoms do break about 1% of the time with slightly higher risk of breakage with rectal intercourse which can be reduced by using a non-oil based lubricant.  

In answer to your specific questions:

1) for any STD how worried should I be what would you say about the risks if condom wasn't flipped?

2) coming out of a relationship I am worried about how my anxiety will ever go away any advice?

3) assuming the condom touched for a second but he realized wrong side and it was flipped what is the risk levels then?

4) testing needed, recommended or good to do regardless of the experience? I am planning to get tested regardless but does this necessitate it more?

I hope these perspectives are helpful to you.  EWH

1. Just to clarify, You have mentioned risk is close to zero so I am understanding you are saying that I should not be worried and move on? For my specific experience you don't think that testing is needed?

2. If I want to get tested regardless (just to be safe for my and any future partners sake) would a 4 week after exposure be a good enough time for an almost conclusive result? I understand it may take longer on some rare cases so what would you recommend to someone with a clinically diagnosed anxiety disorder patient.

2.  Testing can be reassuring,  At 4 weeks following an exposure, a 4th generation, combination HIV antigen/antibody test would detect over 98% of recent HIV infections.  We have never seen a person with a negative test  at 4 weeks go on to become positive.

It sounds like a test would be reassuring for you. They are easy to do.

EWH

I actually had one more question that's is more educational which I wish could be communicated more frequently. 

In many cases the symptoms of some STIs are documented and depicted as very extreme cases. They appear to be very clear to indicate the disease from images. That said in many medical articles it is stated symptoms may be very difficult to notice and asymptomatic even for some cases. Is there any specific educational materials you can share or recommend that would show real life but a more typical (not extreme advanced) indicators and symptoms so one could identify on their partner or themselves. Even with a clean record of sexual history, transmissions can happen after all.

Perhaps this replies, helpful. Either way, it is the third response to this question and therefore, is per forum guidelines, the thread will be closed shortly. Take care. Stay safe, EWH