About a month ago I met another male through a dating app and engaged in oral sex and mutual maturation several times. Tested neg for g/c throat swab at day 5, g/v neg urine at 4 weeks and hiv/syphilis blood at 5 weeks. 

This week I topped him and also bottomed for 1 minute with no friction (just insertion) all comdom protected. We so have rubbed penis to rectal area without condom, no penetration. 

Today, one of those rubs accidentally poked me, with his penis inserting for a split second, and hurted me (got some blood in the first few inches of my rectum), he has no condom on, but also does not precum a lot. 

What is my overall hiv risk here? Should I get pep? Is his neg rapid 4 weeks good enough? I asked him to go test again tomorrow for maximum caution, which would be week 6 after his last encounter, would that result be conclusive? 

Can I keep calm? 

Congratulations on the safe sexual practices and overall approach to sexual safety evident in your message. All things considered, there is little reason for concern about this single lapse in sexual safety. If you are confident your partner has not had sex with anyone else in the month since your relationship began, then you can safely assume there is no risk for HIV:  the chance he had acquired HIV sufficiently recently to still test negative 4 weeks into your relationship is zero for all practical purposes. If he has had sex with others during the past month that you have been together, that would raise the stakes, but only by a little. And even if he were infected, with prolonged anal sex (several minutes) with ejaculation in the rectum the average transmission risk would be about once for every 1,000 exposures. It could be higher than that with a newly acquired infection, but still the odds would be strongly in your favor. And the penetration you describe was extremely brief.

All that said, it was wise of you to suggest your partner be retested, and I'm glad to know of his negative result. (Perhaps there was that advantage in the unintentional delay in my reply!) The only other question is whether he has been having high risk exposures with other partners in the last 3-4 weeks. If so, it is conceivable he has a newly acquired infection and his own test is yet to turn positive. But people rarely lie about their sexual risks when the chips are down in a situation like this -- so if he reassures you he has not been with others recently, probably you can believe him. So at this point I would not recommend that you pursue PEP -- and for sure you can remain calm!

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

HHH, MD

No, I have no reason to think he had had any potential exposure. I went and directly asked and he is also well aware of my safe approach, confirmed no other encounters at all. 

On a follow up question, yesterday (Saturday) I had a badly irritated throat (I wouldn't call it sore, I can easily pass food and water, and feels more like burning). I feel irritation starting in my soft palate and going back to tonsils, with one looking a bit swollen, again no discomfort there, discomfort is mostly at soft palate by uvula. The night before (Friday) we had oral sex, with it being a little on the rough side, 500mg naproxen took care of it, however, did it again several times again yesterday and by morning today, I woke up with the same sort of irritation. 

His penis looks really clean, with no sign of any uncommon secretion (as I mentioned before, he hardly precum, so anything coming out of there is noticeable and me being this aware would have noted anything obvious). Of course, g/c testing is not widely available in Mexico, and thinking on testing just for peace of mind in a few days. 

However, could this conceivably just be irritation, friction or trauma from rough oral? 

Also, pain starts just where hard palate ends, that "border" zone feels itchy to touch even with my tongue.