Broken Condom + Wound. Help.

[dellMPG]

Hello. When I was in Mexico last month I was brought to a spa/brothel. I was drunk (not an excuse, just trying to account for all details in case they might prove useful) and engaged in vaginal intervourse with a female csw there. Our encounter lasted roughly an hour. After finishing inside of her and pulling out I noticed that that the condom had broken at the head but I did not know when it had. There was a good amount of semen in the condom even after pulling out so I am hoping that the condom broke only shortly before I pulled out. Upon my demands the woman insisted she was clean/did not have diseases and had been tested 30 days prior, but I cannot take her word alone. Moreover, roughly a day and a half later I noticed a non-bleeding wound (possibly from friction) on the under side of my penis close to the head. I do not know if it occurred during intercourse with the csw, on the beach the day the exposure, or at the night club I had gone to the following night. Upon returning to the US two and a half days after my exposure, my blood was tested at a hospital and it was negative for HIV. Though asymptomatic, I was also treated for chlamydia and gonorrhea. I will be tested for syphilis later this week. Since then, I have read online that one should wait at least a month after exposure to get tested (which I will do). My question is what do you think my chances of having contracted HIV are? Does the fact that it occurred at an establishment help significantly? To what degree does the wound increase my chances of having contracted HIV if it occurred during intercourse. Do you have an idea of what the HIV infection rates are for female CSWs in non-border Mexico are? Anything else you could offer would be greatly appreciated.

[dellMPG]

Tremendously. I applaud you and your colleagues for the invaluable service you provide. $15 now just doesn't seem enough. Your response has given me more hope than you could imagine.

[Edward W Hook, MD]

You had a single exposure to a commercial sex worker (CSW).  Unfortunately, your condom broke (congratulations for your efforts at safe sex)  Your chances of having gotten HIV or STD from this exposure are extraordinarily low.  Here's why:

1,  Chances are, your partner did not have HIV or STD.  Most CSWs do not.
2.  Your partner said she was not infected, most persons do tell the truth.
3.  Your chance of getting HIV, if she was infected (and she was probably not) is less than one in 1000 per exposure.
4.  You have been treated for gonorrhea and chlamydia. This will not only cure those infections, if they had been there, but also would have prevented syphilis from developing as well.  
5.  As for your wound, remember, you don't know when you got it.  If it was "fresh" at the time you had sex and if she was infected, your odds of getting infected would have gone up a bit but would still be very low.

Bottom line.  STDs - no reason for further concern.
HIV - your risk is low.  Getting tested is reasonable.  At 4 weeks 85-90% of tests that are going to be positive will be, thus when taken in the context of your low risk, can be taken as assurance that you do not have HIV.  Hope this helps.  EWH