I did an extremely stupid thing. I have a wonderful wife and two kids however I got drunk with work friends at a party and ended up at a massage parlour in central London. There were four girls. I went with a Romanian girl. We agreed a price and I asked for a condom. We had protected sex until we were disturbed by another girl who wanted to join in obviously for a fee. We stopped having sex and I said no but as I was saying this the original girl took the condom off. Not sure why!?. I'm sure it was not broke and if it was I'm sure I would remember. We talked for a minute and then I asked for another condom and we had sex again. I did not ejackulate so I stopped pulled the condom off and chucked in the bin and left. I am 36 white circumsticed male. Would like to know the following please.  Odds of getting hiv from this. Odds of other stds. Odds of girl having hiv. Do I need a test. Many many thanks 

I'm not sure I completely understand the removal of one condom and putting on anohter, or why that aspect concerns you. It sounds like you were always protected during vainal insertion. Having had only protected sex, your risk of STDs is low. In fact, even without condoms, a single episode of vaginal is usually pretty low risk; most infections occur after repeated (several to many) exposures. Even among the most sexually active women, at any point in time most do not have transmissible STDs; and all STDs are transmitted inefficiently, i.e. most exposures don't result in transmission. I will also point out that these particular sex workers provided condoms and expected you to use them -- which suggests they usually do so with their clients, and hence may be at pretty low risk themselves.

In any case, since there was no unprotected sex, your risk is particularly low. From a strictly medical or risk perspective, testing normally isn't done in this situaiton. However, I can understand you might want to be tested for additional reassurance. If decide to do so, I would recommend a urine test for gonorrhea and chlamydia, which will be valid any time more than 3-4 days after the event, and blood tests for HIV and syphilis, which are conclusive any time 6 weeks or more afterward. The statistical chances of either syphilis or HIV are extremely low, less than 1 in 100,000 or lower. (Heterosexually transmitted syphilis and HIV are quite rare in sex workers in London.) If I were in your situation, I would continue unprotected sex with my wife -- certainly after the gonorrhee/chlamydia tests.

If seek testing, consider one of London's excellent NHS GUM clinics. There also are excellent private sextor sexual health options in London, such as the Freedom Health clinic.

I hope this has been helpful. Let me know if anything isn't clear. Good luck--  HHH, MD

The reason why she took it off I believe is I think she thought we had finished however in my anxious mind I'm thinking it broke. I'm 99% sure it didn't break as I'm sure it's noticeable when failure occurs and I don't remember seeing this and we did not discuss this which I'm sure we would have.  Anyway I know you don't deal with anxiety on this forum so I have a couple  of follow ups. In the unlikelyhood it did break first time round what are my odds of hiv infection from this one 2 minute exposure.  This exposure occurred 3 weeks ago and I don't seem to have any symptoms.  I had a hiv 4th generation combo test plus the other tests a few years back at freedom health clinic London against doctors advise when I had unprotected sex and it was negative for all STDs and I have not been with anyone else since so I know I was not carry any STDs.  I am planning to have a urine test asap. I am circumcised does this help my case and lastly any stats on one time heterosexual hiv transmission in western world? As mentioned this is to calm my anxiety so that I get on with my life instead of what I am putting myself through now. Many thanks again 

The estimated risk of HIV transmission from a single episode of unprotected vaginal sex, male to female if the woman is infected, is once for ever 2,500 exposures. This figure was published by the US Centers for Disease Control and Prevention (CDC), and can be assumed to apply to most exposures in industrialized countries. You risk would be lower than this, given the apparent brevity of exposure if the condom had broken. Being circumcised doesn't make much difference; your risk would have been slightly higher (but only slightly) if you were not circucised.

Since you have previously been seen at Freedom Health, it would seem logical to see them again for their advice and testing in relation to this exposure.