1. Should I be worried about the oral sex I gave for HIV?  Do I need prep or testing?  

2. I am slated for my regular check in December.  Should I have a swab my throat then if no symptoms or go in about 10 days,

3. I assume the condom protected, no penetration, no breakage is a non-HIV risk event?  Or do I need prep?  Or testing and if so, what kind of testing, PCR in 8 days or anitbody in 30?  I do have protected sex with women occasoinally and get HIV tested annually, december being my next appointment.  

Thank you

This was a near zero risk exposure for HIV (probably truly zero) and low risk for other STI. First, people rarely lie about HIV/STI status when asked directly, so you can safely believe your partner tested negative in June. While it is of course theoretically possible he was infected since then, the exposures described carried little or no risk anyway. You ask about PrEP, but obviously mean PEP (post-exposure prophylaxis):  I definitely would not recommend it. To your specific questions:

1. Oral sex is nearly risk free for HIV. All oral exposures to the virus are very low risk. In the 40+ years of the world wide HIV/AIDS epidemic, there have been only a few cases of HIV documented to be transmitted penis to oral. An analysis by CDC, based on how people thought they acquired HIV (which often was mistaken) indicated a risk of one chance in 10,000 if the penile partner had HIV and wasn't on treatment. That's equivalent to giving BJs to infected men once daily for 27 years before infection might be likely. With those odds I would certainly not advise PEP, especially with a partner who almost certainly didn't have it. Even testing is optional -- but more about that below.

2. The main risk for the oral partner in fellatio is for gonorrhea, but absence of visible pus dripping from his penis is good evidence he didn't have it. Still, you certainly could have a throat swab for gonorrhea if you would find the anticipated negative result to be reassuring. Lack of symptoms doesn't mean much; over 90% of oral gonorrhea causes no sore throat or other symptoms. Oral chlamydia is rare, causes no symptoms, and is cleared even more rapidly by the immune system. Oral herpes is theoretically possible, but very unlikely with no symptoms in the next week or two. Syphilis is possible but also unlikely from any single exposure, especially if you don't develop an oral sore (chancre) in the next 2-3 weeks.

3. Correct, the attempted anal penetration was zero risk for anything, even if your partner was infected. No STI bacteria or virus can be transmitted through an intact condom.

Based on this exposure, testing for anything is optional. But if you decide to do it, it will be safe to wait until December for your regular HIV test, a syphilis blood test, and a throat swab for gonorrhea. (But be aware that oral gonorrhea usually is cleared by the immune system within a few weeks, so a negative result in December would not rule out the slight chance you had it. You could have a test after 4-5 days if this makes you nervous and you would like a more conclusive test.

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

HHH, MD

  Two quick follow up questions.  I did forget to add that right before the attempted anal happened he did lube his fingers and inserted them in my anus.  To my knowledge he had not touched himself prior to entering me.  So...

Unless I have symptoms like fever, canker, sore throat, I'm going to wait and have all testing in December.  Unless my additional information changes something.  Thank you

2. Usually 1-2 weeks, probably sometimes up to ~20 days. 2-5 days definitely is too soon.

The main ARS symptoms are sore throat, fever, enlarged lymph nodes, and skin rash. Canker sores aren't very common.