Appreciate all you do! I am here again with another question to assess my risks. I was at a swingers club last night, where an ordinary looking couple entered one side of a glory hole, I followed and went on the other side.

Due to my previous scares, I always use condoms, even for oral. I placed a condom on and she proceeded to give me oral and then vaginal. However, I slipped out at one point and then she fumbled around and then reinserted me. I ejaculated, and felt something off. I pulled out in the middle of ejaculating and saw that she removed the condom when she was fumbling around with it...

The condoms I use always feel thin and great, so I truthfully didn't notice until ejaculation.

I was a bit rattled and went to the washroom after seeing another man take my place. Where I could tell she did same to him. Before I could speak to the couple, I noticed them leave.

I have been prescribed Doxycin and Biktarvy, and told to take tests today (day zero), then in few weeks, and then another in few months.

I don't know what would possess someone to remove the condom off a total stranger in this context. Which makes me feel like risk is much higher based on her behaviour and likely doing it with alot more people.

Am I over stressing? Or are my risks for HIV, and the garden variety STI's high.

Thanks so much again. 

Having glanced at your previous forum questions going back a couple of years, largely about condomless exposures, I'm glad to hear you now use condoms regularly for potentially risky exposures. Too bad it didn't work out this time, but you tried. (That said, the very notion of anonymous sex via a glory hole is among the riskiest of all possible types of exposure. Maybe you need to think about that aspect in addition to condoms.)

No, I don't think you're over stressing at all. As that implies, this was certainly a high risk exposure and it was reasonable to seek care. You don't say the exact timing, but apparently you've already sought care and have been prescribed both doxycycline post-exposure prophylaxis (doxyPEP) and HIV preventive treatment with Biktarvy. DpxyPEP is highly effective in preventing chlamydia and syphilis, and reduces gonorrhea risk by about 50% (although even that figure might now be declining:  recent research shows gonorrhea resistance to doxy is increasing). PEP with with Biktarvy is nearly 100% protective. Of course I have no way of knowing the actual chance your GH partner had any of these or any other STI, but having put yourself in this position, you're doing all the right things. My advice is to take the drugs as directed and follow the advice of the doctor or clinic you saw about follow-up testing. (However, it is rarely necessary to test for HIV as long as a "few months" later. Your final HIV results probably should be 4-6 weeks after your last dose of Biktarvy -- probably sooner than "a few months."

All things considered, you can expect negative results. But do follow up as directed by the doctor/clinic.

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

HHH, MD

The exposure happened around 10pm last night. Got an appointment the following morning at 11am and started Biktarvy and Doxypep at 1:30pm. I'll continue the medication as prescribed.

I guess my last question is, assuming she was HIV positive, Biktarvy is nearly 100% protective against it? Which I assume is what you meant by expecting negative results at weeks 4-6 weeks? 

I live in Canada, so I'm hoping my odds of catching it to begin with would be lower. But of course, anonymous exposure, with someone who removes a condom... Can't be good odds.

Thanks again

7am is a more manageable time than remembering to take them at the office

Yes, Biktarvy is close to 100% effective. The downside of HIV PEP is that you can't have conclusive testing until a few weeks after the last dose. Otherwise, you could have a valid HIV RNA (viral load) test at 11 days, which would be conclusive. However, there are no data on the effect of partial treatment, i.e. 5 days. I suggest you discuss next steps in regards to HIV with the doctor or clinic where it was prescribed. You'll need testing for gonorrhea and chlamydia a few days after taking doxycycline.