Yesterday in the evening I had sex with a female sex worker from Vietnam who seems to travel around offering her services. I am from Germany and the encounter happened in Germany. She could not speak German and I am also not sure if she offers her service legally here. And I also do not know if she works as prostitute in Vietnam or if she just earns money with this job abroad. I found her on a website and paid 80 Euros for 30 minutes (not "cheap"). She looked clean, without any wounds, scars, smells etc. 

After receiving an unprotected blowjob, she asked me if I want to use a condom or not (so I assume she offers her service also without using condoms). I insisted to use a condom. Then she put the condom on me and at the end of the penetration, just before ejaculating, I realized that the condom is broken. The tip of my penis was unprotected, which means I had unprotected sex for probably a couple of minutes.

I washed my penis immediately with soap and urinated approximately 5 minutes later.

I took "Doxy PEP" (2x 100mg at once) approx. 30 minutes after the encounter (the pills were leftovers from a malaria prophylaxis prescription).

I am anxious now because of HIV.

1. How would you assess my risk?

2. Would you recommend HIV PEP in this situation?

3. Should I do a HIV PCR test after 2 weeks?

4. Which other tests would you recommend?

5. If I do not have any symptoms after ~1 week, would you continue unprotected sex? 

I'm sorry to hear of your condom breakage.  FYI, condoms break about 1% of the time they are used.  Your partner is statistically unlikely to have HIV- by advertising and by charging a relatively high price she is in a group of commercial se workers in whom infections are relatively uncommon.  The doxy PEP you took virtually eliminates your risk for syphilis and chlamydia and substantially reduces your risk for gonorrhea.  In addition to the fact that your partner is statistically unlikely to have HIV, even if she did have untreated HIV, your risk for infection would be les than 1 in 2000- in other words, if she had HIV there is still a more than 99.9% chance you would not be infected.  In response to your specific questions:

Your risk is low.  I would have few concerns. 

I hope this information is helpful.  If there are further questions, please use your up to two follow-ups for clarification.  EWH

Thank you very much for your timely answer, which relieved me somewhat.

I have two follow up questions:

1. Does it matter that this woman is from Vietnam which has a somewhat higher HIV prevalence (0.4% in normal population and much higher in FSW as far as I understand) than other countries like Germany and northern America?

2. Is the risk not higher, because she seems to offer "unprotected" intercourse as a service?

I ask these questions not because I want more accurate odd rations, but because the indication to get PEP here in Germany is that it must be somehow likely that she has HIV (unprotected sex with someone who has HIV is a strong indication for PEP). I am asking myself if both points above makes it likely that she has HIV or if it is still quite unlikely that she has it and as a matter of fact my risk is still neglectible?

1.  That she is from Viet Nam does not change my assessment.  As a CSW who can travel internationally it is reasonable to think that she has taken reasonable precautions and is not at the same relatively high risk that someone seen in a Viet Nam street brother might be.

2.  That she offers unprotected sex does mean that she is willing to take risks but as I implied above, she has a professional interest in testing and taking precautions

No change in my assessment

EWH