On the 16th of July ,(11 days ago) I was stupid enough that I went to see a transgender escort/masseuse after a year of abstinence. During the session with her there was no sex involved and only limited to a 'sensual massage'. During the massage, she performed analingus,rimming and rubbed and poked her unprotected penis head against my anus, however at NO point did it enter my anal cavity or so i think( I am a male btw). I have also asked the csw if she did penetrate me and she assured me that she did not or I would have 'felt' it. Before we started, I did ask her health status and she assured me that she was clean, undergoing monthly tests(of which the most recent negative test was a week before i met her) and following PREP doses for almost 2 years now. Additionally she has recently got her visa done and HIV testing is part of the medical to get said visa.

While I know that analingus and the rimming are not forms of transmission, the 'poking' and 'rubbing' of the penis has got me quite worried. About 3 days ago I have started to get muscle pain behind my right knee and still there today. This in turn has made me very anxious as I read online that muscle aches are a part of ARS.

My question is if the muscle pain is a start of the ARS and if this whole episode given the recent negative  reports and the involvement of PREP is a risk for HIV and if testing is required? 

From your description, this was a zero risk exposure for all practical purposes -- by someone who almost certainly doesn't have HIV. There could be a small risk of other STIs, i.e. those transmitted not by fluids (like HIV) but by skin-skin contact, like herpes, HPV and syphilis. However, even these would be very low ir any risk. In addition, localized muscle pain is not a symptom that suggests a new HIV infection, or any other STI. I'm sure this has nothing to do with the massage experience described.

So you really need not be at all worried, and I don't recommend any testing.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I forgot to mention previously that at the time of the visit I had a pilonidal cyst. It is something I have from time to time and it heals itself. I don’t think it burst at the time but it did go away after 3-4 days of the exposure. In case it did burst, does your advice stand? Also if more symptoms appear in the coming days does that change anything?  

As a last point, what are the chances of my test coming back as positive? I do sincerely apologise if I am being annoying as this episode is absolutely destroying me mentally..

All my replies were designed to prevent or resolve your “destroying me mentally” issue. Did you even read my replies? Why haven’t they helped? Please reread every word of all my comments, paying very close attention. Then if you’re still upset and worried, maybe seek mental health counseling. It isn’t normal to remain so worried after such reasoned, science-based reassurance.

That ends this thread. I hope the discussion has been helpful. Good luck.