There was little if any risk for HIV in this situation. First, it is statistically unlikely your escort partner has HIV. Heterosexually transmitted HIV is relatively infrequent in Brazil. And most female escorts (high end expensive sex workers by appointment, as opposed to brothel workers, bar pick-ups, etc) understand the risks, care about their health, take precautions like routine condom use, and get tested frequently. Second, condoms work effectively to prevent HIV transmission by vaginal or anal sex. Third, as discussed in response to your questions three years ago, oral sex always is near zero risk for HIV.

Finally, the blood you saw makes no difference. In HIV infected women, the amount of HIV is pretty much the same in blood and vaginal fluids. Even without condoms, unprotected vaginal sex during an infected woman's menstrual period does not raise the HIV risk any further. In addition, dried blood can always be viewed as no risk no matter the exposure. HIV does not survive drying out.

In summary, your risk for HIV was zero for all practical purposes and I definitely would not advise PEP in this situation. From a medical/risk standpoint, you don't even need HIV testing. That said, reassurance alone often is a valid reason for testing, even then the risk is nil. If a negative test result would increase your confidence, feel free -- but strictly for possible reassurance, not because of actual risk.

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

HHH, MD