1.  The exposure that you describe was low risk. Most commercial sex workers do not have HIV. Your partner stated that she had been tested and most persons tell the truth and you practiced safe, condom-protected sex. Condoms work. When condoms come off, most often they come off as the male is withdrawing and the condom stays behind having done it’s job. This sounds to be the situation that you experienced.  Finally even if your partner had untreated HIV and your condom came off before you with Drew from her, your risk of acquiring infection is less than one in 1000 (I.e. there is a more than 99.9% chance you would not be infected).

2.  Although I personally would not have recommended PEP in your circumstance, you took it and continue to do so for the reducing your risk for infection.

3.  The symptoms you describe are not the least bit suggestive of HIV. Nor are they suggestive of herpes or HPV. Had you acquired herpes lesions would have been seen by the Doctor Who examined you. HPV lesions would not be expected to be present until at least 2 to 3 months following exposure and are typically asymptomatic.

At this time, my advice is to do your best not to worry. The fact that you are taking PEP means that you will not have a definitive answer as to whether or not you were infected with HIV until at least six weeks after completion of PEP.  Testing at this time however would provide reliable proof that your recent symptoms were not due to HIV. When symptoms are due to HIV, tests are always positive.

I hope this information is helpful to you. If any part of this reply is unclear or you have additional questions, you have up to two follow-up questions to seek clarification. EWH

I would like to ask about the itching and burning on the right side of my penis. The area is still sensitive. I never saw a significant lesion. There was something that looked like a bump, but it wasn't red. Although I am a darker Pakistani male (living in the US) so I think it may be harder to see. At one point there was a small pimple, but I'm not 100% certain. Nothing really prevalent. My mind might have been playing tricks on me. The doctor looked at me 6 days post exposure and assured me nothing was wrong. Whenever the itching/burning increased, I developed a slight runny nose, headache, and slight pain on the right side of my butt. I don't know how much of this was anxiety related. But if the test result was negative for HSV2, could this be related to HSV1 from oral sex, or could it be some other bacteria? Or allergic reaction to hand sanitizer, lysol wipe used on penis, or latex condom? Should I be investigating this further? Or just wait until the itching and burning go away and take heed if it ever comes back. It has decreases significantly (week 3) and I have been using cortisone cream on it. Thank you doctor.

I used lysol wipes in between rounds. I would take the condom off and clean my penis with a lysol wipe then put another condom on. I believe this was done 3 times throughout the hour of sexual activities. You are right that it is what's probably causing the irritation. But could using lysol wipes on my penis in between sexual acts have increased my chance of hiv? As the right side of my penis became irritated.

Also, how confident should I feel with PEP? I know there are very few documented cases. But have you had any patients in your professional experience  of seroconversion after taking correctly and no further exposure risk while on it? Was taking it at 39-40 hours post exposure sufficient? What do you think my chances are with PEP? I know you said my worst chances are 1/1,000 but with pep 20% failure rate. Would this push my chances to 1/5,000?

I am getting tested 2 days after finishing pep. If negative, how confident should I feel after this test? I will be getting tested in 2 week intervals after PEP up to 2 month of testing post PEP.

Thank you so much for your help doctor. I may come back and submit a new thread of questions after my test post PEP.