We had no condoms so I told her no vaginal, just oral. Once while on top of me, she put my penis into her vagina. I was able to pull out within 5-10 seconds then washed off with soap and water. No visual skin breaks or abrasions or active lesions.

I freaked out and went to a clinic 3 hours later. I got IM Rocephin, Rx Doxy, and Rx for PEP (Truvada and Tivicay). Due to difficulties finding Tivicay at a specialty pharmacy, was not able to start PEP until 52 hours after.

Within a couple of days, I started having a lot of itching. The itching continued throughout the PEP. I finished the PEP, took it at the same time every day and did not miss a dose. I finished PEP 18 days ago. Still have some itching, but less.

At day 21 I had one mouth sore. At day 36 I had a sore throat then a stuffy nose. This cold resolved in days. No fevers, swollen glands or rash. My anxiety was quite high so at day 45 (17 days post PEP), I went for a test. I got HIV-1 PCR Test because it was only 17 days not 28 since stopping PEP. Planning to do 4th gen test in a couple weeks. Awaiting results. 

The bottom line is that you were at little or no risk of HIV, and minimal if any risk for other STIs. You really needn't be worried. I would have recommended against PEP in this situation, and also against treatment with ceftriaxone and doxycycline. But that's water under the bridge. It is now clear you did not acquire HIV, and my comments to follow will explain why you can relax and stop worrying; you can expect your HIV tests to remain negative. 

Going to your closing quesiton "How would [you] assess risk [of this exposure]? Without a condom at hand, it was good to avoid vaginal sex. But when that happened anyway, it was so brief that there was little risk. Even with unprotected vaginal sex to completion, i.e. several minutes in duration, the average risk of HIV from vaginal sex for the male partner is once in every 2,500 expsores, if the female partner has HIV. I would estimate your risk to be at least 10 times lower than that, i.e. one in 25,000. And from your descriptiont was It would be extraordinarily surprising if a partner like your had HIV. If we estimate a 1% chance she is infected (which probably is too high!), your risk for HIV became 1 chance in 2.5 million. Had you asked my opinion at the time, I would have strongly recommended against PEP.

The risks of other STIs were somewhat higher but still very low. As for HIV, most exposures to partners with known gonorrhea, chlamydia, syphilis, herpes etc do not result in transmission of the infection. In addition to not recommending PEP, I would not have treated you with ceftriaxone (Rocephin) and doxycycline. That said, they eliminted any chance of gonorrhea, chlamydia, and syphilis and no further testing for them is necessary.

As for timing of HIV testing, the main result of your taking PEP is to delay the time to conclusive HIV testing, prolonging the duration of any anxiety or worry, to at least 6 weeks after your last dose of PEP; and some experts advise 3 months. In other words, until as long as 4 months after the sexual exposure, instead of 4-6 weeks. Having said that, your negative test results 17 days after completing PEP are reassuring:  probably almost all infected persons would have positive PCR tests by that time. You can expect your additional AgAb (4th generation) blood tests to remain negative. But for 100% reassurance, you'll need a final AgAb test at 6 weeks. (Personally, I am confident others' advice for 3 months is overkill. I've never heard of anyone negative 6 weeks after completing PEP later testing positive.)

Finally, your symptoms are not possibly due to HIV. It isn't possible to have HIV symptoms in absence of detectable virus (your PCR result). And in any case, acute HIV infection does not typically cause common cold symptoms like nasal congestion. As you suspected yourself, undoubtedly it was a common cold, nothing more (or possibley Covid-19). But not HIV.

I think those comments cover all your concerns. Let me know if anything isn't clear.

HHH, MD 

One follow up, if I may. I am a bit confused about to what extent, statistically, doing PEP reduces the risk of acquiring HIV. In published figures it seems like the "failure rates" are quite low, but they are only a bit lower than the base rate of per-exposure risks, so it seems hard to tell how effective PEP actually is. Do you have any thoughts on how much PEP would reduce the 1 in 2.5 million type risk?

Which also explains your follow-up question. The general consensus among experts is that PEP reduces the likelihood of HIV by around 90%. If that's true, then a one in 2.5 million risk becomes one chance in 25 million, which is zero for all practical purposes.