On Monday, I (a male) had vaginal sex with a 30-something woman at a massage parlor in California. The condom broke so we were unprotected -- 5 seconds to 1 minute. I've known her for a couple years, but we've only had sex on my last 3 visits. I don't get the sense that she has sex with many clients, as condoms are not provided in this particular parlor. She is a single mother, so she dates around in her personal life. She tells me that she is healthy (a runner) and was tested 6 months ago (for what I do not know). There is no way of telling for sure whether she is "healthy" or what she even means. Some more background: she has had cosmetic surgery, works as a dentist assistant, has tattoos, and was born and raised in China.

My PCP recommends that I have these tests done on Thursday morning and two weeks later:
HIV viral load
Chlamydia and gonorrhea
Syphilis screening by RPR with reflex treponemal antibodies
Trichomonas vaginalis
Mycoplasma genitalium
Hepatitis C screening

Tonight (Wednesday) I do not feel any symptoms such as burning or itching or discharge, nor do I see any visible symptoms.

1. What's my risk level for catching an STI or STD? Really low, I hope?

2. Should I do PEP? Based on the forum, it would seem you think that is overkill in my situation. Do you agree that the HIV risk is way too low to consider this?

3. If I pass the tests on Thursday, is there any concern having unprotected sex with my wife? Is there any risk that the tests may have missed something due to incubation time? She is pregnant.

4. If I pass the second set of tests two weeks from Thursday, is there any concern having unprotected sex with my wife?

5. What's the risk that I've caught something that doesn't show up on the tests or is not detectable by any test? What could these be and am I at high risk for catching them? How would I know if I did?

Welcome to our Forum. thanks for your question. congratulations as well on your commitment to safe sex.  Despite your recent condom mishap, I encourage you to continue to pursue condom protected sex.  It will do much to keep you safe.  Before I answer your specific questions, a few more general comments.  This was a relatively low risk event.  Most people, even most CSWs do not have STIs including HIV and even when they do, most single exposures to an infected partner do not lead to infection.  That said, testing for the most common STIs is certainly reasonable, after all....things happen.  I certainly support testing for gonorrhea, chlamydia and trichomonas, far and away the most common STIs.  Testing for HIV and syphilis are very unlikely but reasonable as well.  OTOH, I see no medical reason for testing for M. genitalium or hepatitis C.  The field of M. genitalium is evolving but at present most experts recommend testing only IF symptoms are present.  Further hepatitis C is virtually never transmitted through vaginal sex.  The vast majority of hepatitis C is transmitted though parenteral drug use and when the infection is transmitted through sex, anal intercourse is typically involved.  finally, the fastest and most direct way to find if you have been exposed is to ask if your partner would test- you could pay for it- since if she is negative, you have absolutley nothing to worry about from your condom failure.  Now, on to your questions:

1. What's my risk level for catching an STI or STD? Really low, I hope?

Yes, see above- very low.

2. Should I do PEP? Based on the forum, it would seem you think that is overkill in my situation. Do you agree that the HIV risk is way too low to consider this?

No, your risk of being exposed to HIV is minuscule, and if , against all odds your partner had HIV, your risk for infection from a single exposure is less than 1 infection per more than 1000 exposures.  further, at this time, it may be too late to start PEP since it is recommended only if it can be started within 72 hours of exposure.

3. If I pass the tests on Thursday, is there any concern having unprotected sex with my wife? Is there any risk that the tests may have missed something due to incubation time? She is pregnant.

No if your tests (or your partner's) are negative, you need to worry about something being missed.

4. If I pass the second set of tests two weeks from Thursday, is there any concern having unprotected sex with my wife?

See above, I would not worry. 

5. What's the risk that I've caught something that doesn't show up on the tests or is not detectable by any test? What could these be and am I at high risk for catching them? How would I know if I did?

Somewhat repetitive question.  There is little risk that the testing suggestive would miss an infection.

Hope these comments are helpful.  EWH

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Dear doctor, thanks for the fast reply. What I meant by question 5 was whether there are any other stds or stis I should worry about besides those being tested, for example, herpes, hpv, crabs, etc. Am I at risk? How do I know if I catch those kinds of things? Is there a point after which I should feel comfortable I didn’t catch these things if I feel fine? Thanks again!

I understood your question.  No, I see no practical reason for testing for other STIs.  The reasons for this statement and are complex.  Bottom line however, the ones you have listed are the ones that are reasonable to worry about.  EWH
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I forgot to mention that I fingered the woman from my previous question before I put a condom on. Would it be possible for me to contract anything from her by touching her vagina and then my penis? For example, warts or other stds? Thanks

No, there is no risk from touching a persons genitals with you hand, then touching your own genitals.  This all falls into the category of masturbation which is safe, no risk sex.  Even with mutual masturbation in which both partners get each others' genital secretions on one another, there is no risk for acquisition of any STI and no need for testing.  You are in the clear.

As per Forum guidelines, as this is my 3rd response to your questions, this thread will now be closed. Take care, please do not worry.  EWH

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