[Question #10133] Syphilis concern

25 months ago

23 April I met a trans escort in the U.K. (from Italy). We gave each other anal sex with condoms (didn’t notice any breakages). Also held our penises together in my hand & masturbated them together. No ejaculate. Didn’t notice any obvious symptoms on her.

5-6 weeks later, a single painless lesion on my penis shaft appears. wouldn’t describe it as an ulcer - 10 days it scabbed over with a brown/reddish scab, which fell off in the shower & opened again. This process repeated until the lesion healed & left a small scar. I went to a NHS Sexual Health Clinic on 22 June (60 days / 8 and half weeks after event) - swabs & bloods done. By this time the lesion on my penis had healed with just scar remaining. A couple of small spots developed on my groin & pubic area.

Results were positive for HSV-1 & negative for everything else. My concern is the lesion on my penis was a Syphilis chancre.

1. What is the Syphilis risk from the situation I described?

2. How reliable & accurate was the antibody blood test at 60 days?

3. I’ve read it can take up to 90 days for Syphilis antibodies to be detected, but also seen Dr Hook state if a Syphilis chancre is present then blood tests would detect Syphilis within 3-7 days of the chancre being present -

Once in this thread (last response to follow-up question): https://www.medhelp.org/posts/STDs/Syphilis-Window/show/1671884

And in main reply, here:

https://www.medhelp.org/posts/STDs/Unprotected-Oral-Syphilis/show/1694644

4. Can I relax?

Edward W. Hook M.D.

25 months ago

Welcome to our Forum. Thanks for your questions and for your practice of safe, condom protected sex. Thanks as well for reviewing earlier threads on our Forums. We make then available so that others can learn from our Reponses to others, something that you have done.

1. What is the Syphilis risk from the situation I described?

This was a low risk encounter for syphilis. From the sounds of things the area of your penis where the lesion appeared was covered wit a condom- as such the condom would have protected you from syphilis. There is no risk for syphilis from the mutual masturbation activities that you describe. Further the characteristics of the lesion you describe does not sound like syphilis- syphilis lesions typically do not scab or bleed and when they heal, there is typically no scarring.

2. How reliable & accurate was the antibody blood test at 60 days?

You results are accurate and should be believed- they indicate that you did not get syphilis from the encounter you describe and that the lesion you noted was not due to syphilis. As you know from the other threads you have reviewed, if this was syphilis, your blood test would have been positive.

The classical and probably out of date teaching (from the 1950's) is that blood tests for syphilis can take up to 90 days to become positive. This is overly conservative and has not been borne out.

4. Can I relax?

Certainly

I hope that this information is helpful. EWH

---

25 months ago

Dr Hook, thank you for your reply.

If I may ask a few follow-up questions to clarify.

1. Just to clarify, the mutual masturbation that I mention was me holding my penis against her penis in one hand - so direct genital to genital contact - would this not be a risk for Syphilis if she had a sore on her penis that I did not notice?

2. I have read in other forums that an antibody blood test at 60 days is roughly 80-90% reliable - is that a figure you are familiar with or would agree/disagree with?

3. Would you stand by your comments in the threads that I linked to, where you say that if a Syphilis chancre is present, then someone would test positive within a week of the chancre showing up.

4. I had my test 3 weeks after the lesion on my penis showed up - does this mean I am in the clear with the negative result?

Edward W. Hook M.D.

25 months ago

Straight to your follow-ups:

:what if" questions are rarely productive. you have already proven you were not infected with your negative blood test. Further, the likelihood that you would not notice a penile sore during the masturbation episode you describe is small. Even if you were exposed in the manner you describe, the risk for infection would be low.

2. I have read in other forums that an antibody blood test at 60 days is roughly 80-90% reliable - is that a figure you are familiar with or would agree/disagree with?

I disagreed with such statements above and still do. Your 60 day tests are conclusive.

3. Would you stand by your comments in the threads that I linked to, where you say that if a Syphilis chancre is present, then someone would test positive within a week of the chancre showing up.

Yes

4. I had my test 3 weeks after the lesion on my penis showed up - does this mean I am in the clear with the negative result?

Yes

I hope these replies will help you to move forward. EWH

---

25 months ago

Thank you, Doctor.

I believe the blood test I had was an EIA test that looks for IGg. Now that I know what test I had, does this change any of your thoughts on result accuracy at 60 days?

Edward W. Hook M.D.

25 months ago

If anything, the EIA tests are more sensitive and become positive before other types of blood tests for syphilis. This result only reinforces my confidence that this is not syphilis

As you know, we provide up to three responses to each client's questions. It is now time for both of us to move forward. This thread is now complete and will be closed. I hope the information I have provided has been helpful. Please don't worry. EWH

---