Hello,  I had a question about potential exposure to STD/HIV and if PEP or further STD/HIV testing is warranted. Unfortunately, I had a serious lapse in judgement today (have never done this before). I was on a trip to Prague and happened to visit a strip club with some friends. A girl there offered me a private dance. I was aroused and then she proceeded to give me oral sex, with a condom on, after which we had sexual intercourse briefly (a few minutes). After I ejaculated, while I was pulling out of her, I wasn't careful to hold on to the condom. I think the condom was accidently left in and might have exposed my penis briefly as I was pulling out. (there didn't seem to be any break in the condom prior to ejaculating, but I did not check afterwards).  I am really worried about my potential exposure to STD/HIV. 

Welcome to the Forum.  you ask a number of questions.  I'll try to help.

1.  Were you exposed?  Perhaps, many commercial sex workers (CSWs) do not have HIV or other STIs.  Further, you used a condom.  If the condom remained behind in her vagina but was still visible hanging out of her it is most likely that your penis simply slipped out of the condom as you exited.  If so, the condom likely did its job and you were protected.  Another indicator that this happened might be the presence of ejaculate in the tip of the condom when it was pulled out. 

2.  Should you use PEP?  this is a personal choice.  There are no known cases of HIV acquired from receipt of oral sex form an infected person so your receipt of oral sex was a no risk event.  As for UNPROTECTED vaginal sex with an infected person, the average risk of infection is about 1 infection per 1,000 exposures.  Not too high but worth preventing, especially for many people who are not feeling lucky.  PEP is not perfect but markedly (in the range of 80%) reduces the risk for HIV and is more effective the sooner it is started.  If you decide to take PEP, I suspect it can be found at your location, perhaps by inquiring at a local sexual health clinic.  PEP not uncommonly causes side effects (mostly GI)  so I caution you that if you are going to take PEP PLEASE commit to completing the course and to seeking follow-up from an informed clinician upon your return home.

3.  Other STIs.  The major risks from an exposure of this sort are for chlamydia, gonorrhea and trichomoniasis. Again, the majority of exposures to infected partners do not lead to infection.   Testing can be done using a urine test and you can expect accurate results if testing is performed any time more than 3-4 days after your exposure. 

I hope these comments are helpful.  EWH

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Dear Dr. Edward Hook, thank you so much for your opinion.  I have a a couple of follow up questions. 

You did a good thing to go back and talk with your partner. From the sound of things, this was a very low risk exposure and your condom did it's job.  Given the information you have gathered, if I were you I would not take PEP..  Using the same reasoning, I would not be worried about STIs,  whether or not you pursue testing at this time is up to you. If you test I anticipate the results will all be negative.---

Thank you Dr. Hook. I did not pursue PEP.  I will most likely test at 28 days just for peace of mind.  Thanks again a lot for your guidance and timely responses. Much appreciated!

Thanks for your thanks.  We want to help.  I am confident your tests at 28 days will be negative.  Take care.  EWH---