This is very similar to your previous thread 2 years ago, question #5800 -- except this time you have more detail about your partner's sexual lifestyle and risks. I agree you "messed up", but perhaps not as seriously as you fear; it's a medium or mixed risk situation. Forty partners by age 22 is a pretty active sexual history, especially for someone who leaves condom decisions to her partners (at least some of the time) and acknowledges some (many?) unprotected exposures. And "doesn't remember" her last STI/HIV testing really isn't plausible:  probably she was being evasive and/or it was quite a while ago. On the safer side of the ledger, you used condoms for vaginal sex, and even without condom protection, oral sex is relatively low risk for all STDs and essentially zero risk for some, including HIV, chlamydia, trichomonas, HSV2, and hepatitis. But significant risks exist for gonorrhea, herpes due to HSV1, and nongonococcal urethritis (NGU). The chance she has either HIV or syphilis is quite low, and HIV is close to zero risk in your situation even if she has it.

What tests to have? I would only recommend urethral or urine testing for gonorrhea and chlamydia, valid any time 4 days or more after the event; and blood tests for HIV and syphilis after 6 weeks. For HIV, this should be an AgAb ("4th generation") test; any standard test for syphilis is OK. The main discussion in your previous thread 2 years ago addressed the reasons no other tests are recommended in absence of symptoms that suggest a need. Take another look at it and let me know if you need more. (We also addressed HPV that time, and the reasons this isn't an important concern in this situation.)

Of course all this assumes you don't develop symptoms like penile discharge, painful urination, or genital ulcers, blisters, or sores in the next 10-20 days. Probably you will not -- and that alone will be a strong indication you weren't infected with anything significant.

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

HHH, MD

Not more than one in a thousand women with her sexual history would be expected to have HIV -- but there are exceptions, of course. But if she does, you really weren't at risk:  condoms work, and there has never been a scientifically proved case of HIV transmission by fellatio, i.e. oral to penis. (And only a very small handful in the opposite direction, i.e. penis to oral.) In any case, her HIV result probably will be negative, in which case you won't really need testing at all except for its reassurance value.

As for "just crazy" HIV test advice, anybody can legally say pretty much whatever they want online or in health information literature. However, no responsible, knowledgeable authorities or experts recommend testing for HIV beyond 3 months, and almost none beyond 6 weeks using the AgAb tests. Those with such advice either do not understand HIV and its diagnostic tests, or are stuck with assumptions based on older HIV tests no longer in use; or intentionally take a hyper-conservative stance, perhaps with an unstated goal of intentionally causing worry as punishment for a sexual lifestyle of which they disapprove (IMHO). 

The HIV AgAb tests are positive in about 75-80% of infected persons by 3 weeks, 95% by 4 weeks, and 100% by 6 weeks. But please do not focus on testing as the main factor to judge whether you had HIV; re-read my initial reply above about the other factors in your favor and the very low risk you caught HIV. Also if your partner tests negative for HIV, it will mean you were not exposed.

That completes the two follow-up exchanges included with each question and so ends this discussion. I hope it has been helpful. Best wishes and stay safe.