Greetings and happy new year.  I am a 32 year old male and I am uncircumcised.  I had sex with a commercial sex worker in Mauritius and my exposure included unprotected oral sex (receiving), unprotected cunnilingus (giving) and protected vaginal sex.  I had fingered the lady deeply with my saliva and immediately after removing my fingers from her vagina, I grabbed a condom packet, tore it and put on the condom.  Whilst putting the condom i accidentally touched the inside of the condom and the the sides.  So there may have been some vaginal fluid that went inside the condom, touched my penis directly and I had sex with it for about 10 minutes or so.  I am a bit apprehensive that I may have been at risk from the exposure described.  My last tests were in November 2021 and all has been clear - negative.   Do i need testing for HIV or any STD from this exposure?  

This is my first encounter with a CSW.   I came out of a relationship in October 2021 as I found out that my partner was cheating on me and had my test HIV and STDs tests  in November 2021.  All were negative in November 2021.  Please let me know your thoughts for HIV or other STDs.  I am very scared about HIV.  Thank you.

The risks for STI acquisition vary with the sites of exposure and type of activity.  There is no risk for any STI, including HIV from the potential transfer of genital secretion's to a partner such as may have occurred when you put on your condom after masturbating your partner.  Further, condom protected sex is typically safe sex.  STIs however can occur from giving and receiving oral sex.  HIV is very rare from performing oral sex on an infected partner, occurring in less than 1 in 10,000 exposures (i.e. 99.99% of exposures to infected partners do not lead to infection) and there are no proven cases in which HIV has been acquired from receiving oral sex from an infected partner.  I would not be worried about HIV related to the exposures you report.

In contrast, gonorrhea and rarely chlamydial infections may result from giving and/or receiving oral sex.  Since most commercial sex workers do not have STIs and most exposures to infected partners do not result in acquisition of infection, your risk for infection from the exposures are low.  If it has been more than 5-7 days since exposure and you have no symptoms, your likelihood of infection is lower still.  Depending on your own level of concern, you may wish to be tested for gonorrhea and chlamydia, using a urine test related to your receipt of oral sex and a throat swab related to your performance of oral sex on your partner. Otherwise I see no need for other testing.  

I hope this information is helpful.  If any part of this response is unclear or further clarification is needed, please don't hesitate to use your up to two follow-ups for clarification.  EWH 

I have been given 2g of Azithromycin single dose orally as prophylaxis this morning by a health practitioner in public and sent home.  I have already taken the 2g Azithromycin as a single dose this morning and had some diarrhoea only as side effects.