Should I try and get PEP? I am very anxious over a recent exposure, and I have a girlfriend and life I really don’t want to ruin. Should of thought of that ahead of time I guess. 

I got a female escort to come over to my house yesterday, it was only only about 10-15 minutes. She put the condom on me, used her mouth to lube it up, and then got on me and rode me until I was done. When we were done I could see the condom was holding my cum, and there was no apparent rips or tears that I am aware of (I still have the condom). I don’t know if I should try for PEP or if I was at any real risk from this incident. As far as I’m concerned, the condom did not break, and the head of my penis was absolutely covered the whole time. When she was leaving it looked like possible needle marks in her arms, which I suspect puts her at a higher risk. I am in Nova Scotia, Canada which I believe has a fairly low HIV prevalence, however if she is an escort girl and possible drug user, I am not convinced I will get HIV from this exposure. 

Welcome to our Forum.  As luck would happen, I was on the site when your question arrived so you are getting a response far more quickly than is normally the case. 

Both of the exposures you describe are very low risk for HIV.  Exposure by exposure:

First exposure.  You do not know that your male partner had HIV and from a statistical perspective it is unlikely that he had HIV and even if he did, your mathematical risk for acquiring HIV from performing oral sex on an infected male is less than 1 infection per 10,000 exposures- very low and probably not something I would worry about.  Further, if it has been more than 72 hours (3 days) since the exposure, it is too late for you to benefit from PEP.  PEP should be started within 72 hours of exposure to be beneficial.

Second exposure.  As you point out HIV is uncommon in Nova Scotia and most cases occur among MSM.  Less that 20% of HIV detected in Nova Scotia occurs in women although, as you point out, drug use in particular and to a lesser extent commercial sex work may increase the risk that your partner was infected.  On the bright side however, condom protected sex is safe sex with close to no risk for HIV and, as you point out, your condom remained intact.  Further, it sounds as though your partner may regularly practice safe sex, making it far less likely that she has HIV at all.  Even with unprotected exposures to infected partners, the risk for getting HIV from a single episode of unprotected vaginal sex is less than i infection per 1000 exposures and with a condom the risk declines to less than 1 in 100,000 exposure to infected partners.  Thus this too was a virtually no risk event.

Were I you, I would not seek PEP for either of these exposures however the issue of PEP is a personal choice.  At least here in the U.S., if you wanted PEP badly enough, I suspect that you could get it.  PEP has its own side effects (mostly GI upset) and cost (perhaps not in Canada) and your exposures were quite low risk.  As i said, i would not seek it. I hope this perspective is helpful.  EWH

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I have a girlfriend (live together / 7 years) and I don’t want to risk infecting her. Should I avoid contact with her until I get tested? Does this exposure warrant testing in your mind? 

I’m completely lost in all this and I feel like I have (or about to) thrown so much away. 

I’m very scared now that I will contract HIV. I don’t know what to do next

The girl was an escort and got rather offended when I asked for her status. She said she was “clean”, and even went as far to say she wasn’t a “junkie”, she just has eczema. Even though I didn’t mention or ask about the “needle” marks.  And then she has since ignored me. Further raising suspicion. 

And should I not have sex with my regular partner? 

Testing is not something that I feel is essential at this time but at the same time, this encounter clearly has you worried and testing for the important possible infections, gonorrhea and chlamydia in both your throat and urine is easily accomplished and might be reassuring.  As far as HIV is concerned, testing so soon after the encounters has little to offer.  HIV testing with the currently used, combination HIV antigen/antibody combination tests is about 99% sensitive at 4 weeks and 100% reliable at 6 weeks.

I would not be worried about sex with your regular partner if I were you.

I hope these responses are helpful to you.  As per Forum guidelines, now, after this 3rd (4th actually) response, this thread will be closed later today.  Please don't worry and take care.  EWH