Broken Condom - immediate withdrawal - am I at risk?

[Yay Joe]

Case Facts: On 4th June, around 5 am I had insertive anal sex with a crossdresser (so, a male, for the purpose of this question). When I pulled out (after coming), I realized that the condom had broken and on the tip of my penis there was blood and granules of his feces. I washed myself with an antiseptic and approached an “Infectious Diseases” doctor who somewhat reluctantly (because as per her, the risk was not high) prescribed a PEP regimen. However, despite repeated requests, I could not get the other person to get tested for HIV. He simply refused, and was somewhat offended. As per him, the reason anal fissure occurred was because he was a “virgin”. He also claims to have never shared any needles with anyone. However, I assumed the worst and requested the doctor to give me PEP.
So, effectively, I was on PEP in less than 6 hours after exposure. The medication was a single pill (combination of Efravirenz, Lamivudine and Tenfovir Disproxil Fumarate), to be taken every day. I took the pills, as prescribed, but due to side effects, discontinued it for 2 days and then started again. I could not do a baseline testing the very same day, so I returned to the hospital for a baseline testing after 1 week and my result indicated that I was nonreactive.
After about 10 days, I developed a small wart. I went to the hospital again, this time to a different doctor who specialized in HIV. He made me undergo a test for Syphilis, HPV, Hepatitis A and B. For all these too, my results were negative. The wart completely disappeared after a week. I finished my PEP as per the plan (except the two missed doses). I will get another test done after about a month and then yet another one after about 3 months.     
Questions:   
1)   Was my first doctor too complacent in saying that I did not need PEP? (I was the insertive partner; I am uncircumcised and I have always had protected sex; In this instance, the condom broke, without me realizing it)
2)   2 days after finishing the PEP regimen, I have a runny nose and sore throat. Should I be concerned?
3)   How successful would PEP be in my case, given that I missed 2 doses? Also, towards the last 10 days, I used to take a light meal occasionally after the medication: could this have lowered the efficacy of PEP?
4)   I have lost about 5 pounds of weight, and I feel fatigued throughout the day. How long can I expect this to continue?
5)   And finally, in your assessment, could I have gotten HIV because of the activity described above?
Apologies for the somewhat lengthy description. I’d deeply appreciate if you could reply, as you have replied to hundreds of other people on the forum.

[Joe K]

While you did have a risk, the risk is lower for the insertive partner and you were protected until the condom failed.  PEP is generally not recommended in cases such as yours.  PEP also has an excellent record at preventing infections and missing two days will not diminish the effects of PEP.

You can test 6 weeks from when you finished PEP and then at 13 weeks to confirm the results.  You also should never insist that a partner test as the only status that matters is yours.  Given the level of your risk, I expect you to test negative from this incident.

Joe

[Yay Joe]

thank you for the reply. The reason I was insisting the partner to test was because my doctor suggested it. As per him, if the partner tested negative, I could discontinue with the PEP as I couldn't have gotten an infection from someone who was negative.

Also: I just checked the dates again. The exposure happened on June 4th and I got my HIV test done on June 16th. I know 12 days is too early, but still, should I expect a different outcome when I test again around August?

[Joe K]

I would expect you to continue to test negative, given the effectiveness of PEP and your low level of risk.

Joe

[Yay Joe]

Hi,

I had sex with a CSW and while attempting anal sex with her, my condom broke. I realized this immediately and used a new condom. For a few moments I may have been exposed to her vaginal/anal fluids. Am I at risk? And should I go for PEP?

[Ptrk3]

If the condom did, indeed, break and you actually did have anal sex with a CSW of unknown status, however briefly, you had unprotected sex with her, so, yes, you may be at risk for HIV infection. 

However, since you were the "active" participant, your risk activity is not as risky as other actions.  You can get a perspective through these links:

https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/understanding-risk-activities/

http://www.aidsmap.com/Estimated-risk-per-exposure/page/1324038/

Whether you seek PEP is your decision, in consultation with your health care provider.  In any event, you should test for HIV antibodies six weeks past exposure and 13 weeks after exposure for confirmation of the six week results.