Sex with a high risk person, a massage lady from Vietnam, mid 40s, barely spoke English and may be operating in an illegal premises (in Australia) in a high Vietnamese community location. This same location has also launched a sexual clinic and is targeting foreign speaking people in the area to educate them of STD transmission risks, as it's an area of concern (I know this now, not before).

Used a Condom, it was on and covered about 70% of the shaft, it felt small and I couldn't roll it to the base, so part of the bottom of the penis was exposed. This is important as I have HSV-2.

Penetration was partial, I'd say 70% covered, but can't confirm. About 1 min with light vaginal intercourse (slow movements), I changed positions and noticed blood on the condom and outside of the vagina. I had inspected the vaginal area for anything before I entered, but didn't open and look inside. When I pulled out of her, the condom had visible blood, some even splashed out on the outside of her leg as I pulled out. I assume she was on her period.

Condom was removed quickly with a wet wipe, then another wipe was used to wipe my penis - didn't see any blood on the second wipe, but was a little dark. Also I didn't inspect the state of the condom either. I immediately rushed to a shower < 2 mins later and washed the area.

I asked her about her health status, but she couldn't speak English. I used a translator app to Vietnamese and she still didn't respond properly, she instead ran off and rushed me out of the place - fueling the anxiety.

I called the health clinic to ask if PEP was needed, they said no based on the circumstances, but I forgot to mention HSV-2 to them.

I need to know what the likelihood is of contracting anything.

Since you imply you're in Australia, that's the focus of my first thoughts. Australia's health providers in general are sophisticated in STI/HIV prevention, risk, treatment, etc. In my judgment, Australia's federally supported sexual health centres are, collectively, the world's very best network of sexual health and STI/HIV clinics. For clinical assessment or advice, you'll never go wrong by contacting your nearest SHC. 

Comment on your opening line, with "high risk person":  from what I know of STI/HIV epidemiology in Australia, I'm not sure I would classify your partner as high risk. The chance she has HIV, assuming that's your main concern, probably is low. But even if she did, you describe a safe sexual exposure. It is entirely normal and expected for condoms to permit substantial skin-skin contact above the condom. This is why condoms are less effective against the STIs transmitted skin-to-skin (HSV, HPV, syphilis) while remaining virtually 100% effective in preventing those transmitted by genital fluids (e.g. chlamydia, gonorrhea, HIV). Blood contact during sex doesn't raise the risk of HIV:  the amount of HIV in vaginal and other sexual fluids is just as high as in blood. (For example, unprotected sex with a menstruating HIV-positive partner is no higher than otherwise.)

Your remark about HSV2 implies you are aware that this raises the risk of acquiring HIV. But this really isn't a very important issue. It roughly doubles your risk of HIV if exposed. But "double" isn't the big deal it might seem. If the starting risk of HIV is one chance in a million (which probably is a good guess for your situation), double means the risk is still only one chance in 500,000 -- still zero for all practical purposes.

The condom wiping business doesn't sound at all alarming. 

For all those reasons, I agree that PEP was not warranted by this event. My guess is that they didn't even recommend testing. (And as implied above, I definitely agree if the "health clinic" was one of the municipal SHCs!)

I really don't think you should be worried at all. I don't even recommend testing for anything.

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

HHH, MD

You are correct about the Australian health services. I was concerned because despite a reduction in M2M HIV cases, there has been an uptake in heterosexual cases, particularly in communities where English is not the main language (according to a 2023 report). It was this and the response from the massage lady that triggered my suspicions, as whilst the reported numbers are going down, there is still likely to be unreported HIV cases in the wild - and these particular communities discourage condom usage.

Regardless, you're correct in that the transmission risks for HIV are low. I couldn't find any figures on transmission rates of HIV that are specific to my situation (ML, protected, menstrual blood and HSV-2) so I was looking for some clarity. Unfortunately Dr. Google is not your friend, Reddit is pure evil and I can never tell who is being completely truthful - one such forum "aus99forum" is about Aussie people who share ML stories, including LOTS of barebacking and even a case of HIV.

It's anxiety getting to me - it seemed so easy to acquire HSV-2 in my 20s despite always using a condom (never knew skin to skin), I've been on edge ever since.

The clinic said I'd be fine. The pep/prep hotline said I wouldn't need it and that I could take a 4th gen HIV test in 2 weeks to be sure, but they advised against PEP too. Neither knew of my HSV-2 condition, thus my concern and the reason I am losing sleep.

Thanks again for your professional opinion. I sincerely hope you never hear from me again for all the right reasons.

While I understand your reactions to getting HSV2, that unlucky experience doesn't significantly change your STI risks. Partner selection, condoms, and partner numbers are the name of the game. For the reasons discussed above, your HSV2 really makes no practical difference in your risk for HIV. In fact, research in recent years has found no association of HSV2 with HIV risk in the US and perhaps Australia -- unlike the studies several years ago, mostly in Africa.

The "need" for HIV testing is entirely up to you. With the events you describe, if somehow I were in your situation, I wouldn't feel the need and would continue unprotected sex at home with no worry about infecting my wife. However, reassurance ("peace of mind") is a valid reason for HIV testing even when risk is zero or close to it. You definitely can expect negative results.