Hello doctor, I would like to ask your opinion about my situation. During oral sex, my throat and pharynx were significantly irritated and there was active bleeding in both areas — at some moments quite a noticeable amount of blood. The bleeding has now stopped, but I am concerned about the risk of HIV transmission in this case.

My partner had an HIV test 40 days ago which was negative, but it is possible that they may have had risky contacts since then. I am a passive gay man, which already places me in a higher risk group for HIV. I live in Turkey, where PEP is not always free of charge and it is very expensive for me.

Do you think in this scenario I really need to start PEP, or would careful HIV testing follow-up be sufficient? Thank you very much.

The encounter you describe was low risk.  You do not know that your partner has HIV and given the fact that until 40 days ago he has remained HIV negative makes it likely that he still is negative.  Further the estimated risk for acquiring HIV from an infected partner due to performing oral sex is low, about 1 infection in 10,000 acts of oral sex on an infected partner (in other words even if your partner had HIV there is a more than 99.99% change that you would NOT become infected.  That your throat was irritated does not change this estimate.

PEP is always a personal choice for all of the reason we have discussed in the past.  Personally, I would not pursue PEP for the encounter you describe. 

Finally, given th problems that you have had in th past as well as the concerns you express now, I wonder if you have concerned starting PrEP.  It is widely available and highly effective.   EWH