Hello Doctor, its been quite a while.Hope you're well in these uncertain times.

A couple of weeks ago, i had sex with a csw. We are engaged in unprotected oral, and protected vaginal sex. The problem is the condom tore during sex and my penis was unprotected inside her for no more than 5 minutes, but i would personally put it at less than 2-3 minutes. Once we noticed we stopped having sex and she followed this by giving me a handjob until ejaculation. Due to a language barrier, I did somehow manage to ask her she had any diseases and she said she didn't. She also stated that she always uses condom and by the looks of the brand(world no 1)  she brought i am slightly more inclined on believing her.

I did go to my std doctor for advice on pep, and he stated that he would not prescribe it personally as he considered it a low risk event and also that i was reasonably safe as per the 'statistics.'I have had a multitude of symptoms ranging from muscle pains in the arms, neck, legs and inner thighs from day 7 till 15, however these have not been constant and come and go at random times. After this they subsided quite a bit, however as of 2 days ago have returned but not all. One of the things thats troubling me is random pain in arm pits that started 2 days ago too. 

When these happen they dont last more than 30min-an hour and just happen randomly.I have not had any fever,sore throat or rash till date since the event. Nor have i experienced swollen nodes or so i believe. My highest recorded temp was 37.2 last night which is up from its usual 36.5-36.8 range.

1. What is my risk of acquiring HIV from this event? Do you agree with my doctor advice on not taking pep?

2: I will be going this week for testing, as per the facts stated above, do you believe that my results will return negative?

Congratulations for having safe sex, i.e. using condoms with commercial sex workers. Too bad the condom failed, but usually that can't be helped. With at least a couple of minutes exposure after the condom broke, this should be considered an unprotected vaginal sex event.

Looking back at your previous threads, your first question (3 years ago) cited the published CDC estimates of HIV risk for individual exposures, including the estimate of 1 in 2,500 (4 per 10,000) for unprotected vaginal sex with an infected female partner -- and the very much lower estimated risk for unprotected oral sex, 1 in 20,000 for oral to penile transmission. These still are the same figures we use on this forum for risk calculations. So if we take these figures and estimate a 1% chance your partner has untreated HIV, the likelihood you acquired HIV calculates as 1 chance in 250,000. (We can ignore the oral sex and hand-genital contact.) And probably even lower risk than this:  given your partner's confidence she is HIV free, the 1% chance probably is too high -- 1 in a thousand might be a more valid guess, bringing your risk to something in the range of 1 chance in 2.5 million.

I agree exactly with the advice you had from an STD physician:  I also would not have recommended PEP in this situation. Also, your symptoms are not at all suggestive of acute retroviral syndrome (ARS, i.e. initial HIV symptoms) which do not come and go in the way you describe. And there is nothing abnormal about the body temperatures you report. 37.0 is not the maximum normal temperature, but the average across all humans and over time in any person; everybody's temperature varies over the course of a day, from typical low values ~36C to highs up to 37.6C (typically higher in the afternoon or evening than morning or mid-day). 37.2C or a bit higher is to be expected from time to time.

Those comments cover your first question, and I am confident your HIV test will be negative.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD