I made the biggest mistake of my life and am completely going insane with worry.  Approximately 3 days i go i met up with a transexual from grindr with the intention to receive a blowjob.  The girl asked for payment and i agreed.  At some point due to alcohol on thing led to another and i have had unprotected insertive anal.  The total duration would be about 2 to 5 minutes of that due to not being able to maintain erection. and is the only time i have every engaged in anything like this in my life.  I know it was completely dumb and am fully aware of how unsafe it was.  Immediaetly after i left and in my haste deleted the app and lost all contact so i had no way to ask about status.  It did take place at her personal residence but i feel uncomfortable showing up there.  So with that said at 54 hours i got on pep which is truvada and trivicay.  I wish i had started sooner but had trouble with my insurance and receiving the medication.  So my question are as follows what would you say are the chances given this information that i will be positive and the end of the PEP course.  Also have you seen another situation with brief duration on a single one time exposure while also taking  PEP turn out positive.  I am extremely OCD and have not been able to sleep and cant stop thinking about how i ruined my life.  I fully intend to finish the PEP and test at according times but i am having such a hard time dealing with a mistake that was so preventable.  

I never say any blood and like i said it was brief with no ejaculation due to losing erection.  

Please let me know what you estimate what my odds of coming out of this ok are as i am sick with worry.

This was my first and last experience like this and have always had negative test come back during my annual checkups the most recent being about 2 week prior.

You don't know your partner has HIV; and if she does, there's a good chance she is on anti-HIV treatment. In presence of HIV, not on treatment, the average transmission risk from a single episode of insertive anal sex (for the insertive/penile partner if the anal partner is infected) has been estimated at 1 chance in a thousand (actually 11 in 10,000):  AIDS. 2014 June 19; 28(10): 1509–1519. doi:10.1097/QAD.0000000000000298.  Your risk was lower still, given the relatively brief exposure, and PEP is highly effective -- started a little more than 2 days after the event, probably ~90% effective. And remember that these figures apply only if she has untreated HIV. If we guess a 10% chance she's infected but not on treatment, considering all these issues I would compute the chance you will end of having HIV at no higher than one chance in 100,000. I've personally never been aware of a patient in your situation who turned out to have HIV.

What have you been advised about follow-up testing? And what sort of provider are you seeing for PEP? If not an HIV expert or an infectious diseases or STD expert, consider seeking out such a person or clinic for ongoing advice about follow-up, timing of testing, etc.

My final thought is probably one you've had yourself:  in the event of similar sexual choices in the future, ask your potential partner about HIV status ahead of time, and stop the proceedings if positive (and not on treatment), don't know, or seem evasive about it. People rarely lie when asked directly, and you'd be a lot less worried in this situation. Not intended as a lecture -- just a word to the wise, e.g. for other readers of this thread.

As I said at the start, the odds are strongly in your favor. Hang in there with PEP and follow-up testing, but do your best to relax. I hope these comments are helpful. Best wishes and stay safe.

HHH, MD

   Thank you for the reply.  I have been trying to deal with this the best way i can and be patient but have found myself going deeper into depression and worry regarding the issue.   Your reply gave me brief reprieve but over the last three days i havnt even gotten out of bed fueled by worry.  So couple quick questions.  Firstly is the ten percent chance a statistically fact or was it an estimate?  Also i know you said you havnt personally been aware of a patient who ended up testing positive give the circumstances, does that mean there is no realistic chance I have of testing positive if i adhere to taking my medication daily as prescribed.  Should i approach the next three months as if I will test negative?  Im sorry for repeat questions but im scared out of my mind and becoming depressed.   

Also as far as other STDs i know the timeframe for testing but i wanted to make sure i got a corona test before i put anyone at risk even a medical professional.  So i finally got my test back yesterday negative for corona.  But i have experienced no symptoms of other STDS no pain when urinating and no discharge.  Does that seem like i have pretty good chances when i do go get tested for those that they will come back negative as well.  I appreciate all responses Im just looking for some reassurrance as the next few months are going to be hard on me mentally.

The 10% guesstimate about the chance your partner had HIV was just that, a rough figure for the purpose of forging the statistical calculation. It's on the high side for most settings, cities, etc. And these days, most HIV infected people know it and are on effective treatment; in that case, HIV cannot be transmitted sexually.---
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