Welcome to our Forum and thanks for your question. congratulations as well for your commitment to safe sex through asking partners regarding their status as well as regular testing.  In my opinion, overall, the risk related to this most recent exposure is low.  As you point out, your January test results effectively rule out having been infected with HIV in your Nov, exposure.  I'll be glad to make a series of comments which I hope will help you to think through your decision about when to test.  FYI, I am presuming that your partner was female.

Comments:

1.  Licensed CSWs in Australia are supposed to be tested regularly.  As you point out, the prevalence of HIV in CSWs in NSW is low. This would reduce the likelihood that your partner was infected.  That she was reported to be taking PrEP would reduce the likelihood that she was infected still more.

2,  Current estimates are that, if your partner had HIV (which I think is unlikely), your risk for becoming infected would be on average, about 1 in 1200.  These estimates do not account for the duration of exposure and given the brevity of your exposure, I  would think your risk would be, on average, still lower.

3. The observed small tears noted on your foreskin do not change my estimates in any way.

4.  The symptoms you describe are not those of recently acquired HIV (i.e. the ARS) but as more compatible with a non-HIV respiratory tract infection - runny nose, productive cough, run down feeling and I note that you do not report any of the classical signs or symptoms or the ARS (high fever, severe sore throat, muscle and joint aches).

Putting these thoughts together, I do not see a need for testing sooner than you might otherwise.  While your behavior is risky, your risk from the single encounter you describe is low and would not raise concerns regarding HIV for me. 

I should also add that I trust that when you test, you are also tested for other, curable bacterial STIs such as gonorrhea, chlamydia, etc. 

I hope that these comments and the information provided are helpful.  EWH

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Many thanks Dr. Hook, your reassurance is both welcome and thorough, thank you. I understand I can ask two follow up questions which I will avail myself off, if that is ok with you. Firstly, recognising ARS symptoms is a vexed issue, would it be fair to say that the symptoms are at the higher end generally? I.e., a fever would need to be significant and more than a day or two, the sore throat pain like a step throat etc? I did feel hot at the weekend and my temp may have gone high once or twice, but wasn’t prolonged. To be fair it was very hot also. 

Thanks for your thanks.  I'm pleased my comments were helpful.  Regarding your f/u questions:

1.  You are correct. Symptoms are prominent for the ARS and tend to be severe.  Some patients I have had with the ARS report it as like being "the worst case of the flu you could imagine."  Fevers tend to be high, the sore throat and muscle aches severe.  Please keep in mind however that only about half of persons who acquire HIV experience the ARS and thus looking for symptoms is NOT a substitute for testing. 

2.  Small cuts and abrasions.  From a theoretical perspective small cuts and abrasions could act as a "portal of entry" for HIV to enter the body.  The true contribution of such non-infected lesions is not known and certainly is less risky than the sores associated with infections like syphilis or herpes.  The reason for this is because in the infections mentioned, the infection causes lymphocytes and other target cells for the HIV virus to accumulate in the base of the open sore, facilitating infection. the presence of herpes or syphilis sores is thought to increase the risk for infection 3-5 fold.

EWH

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Thanks again Dr. Hook, great explanations. Totally noted on ARS and I’ll maintain my testing regimen. And thank you for the clarification on the cuts element. I think if more forums took the honest, direct approach of you and Dr. HHH, (particularly male Herero risk) I feel a lot of hiv anxiety would be dealt at source. Thanks again, feel free to close off - will raise a glass to your good health this weekend. 

Thanks so much.  Closing the thread now.  Take care, stay safe.  EWH
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