I’ve been reading your responses on this forum and it’s way more enduring than other online sources knowing your background.

My case:

On 27th of June I (M) had unprotected oral and protected vaginal sex with an escort, relatively high end from Eastern Europe. I did an urine and blood test at the clinic 5 weeks after (August 1st) for chlamydia, gonorrhea, syphilis and HIV - all negative.

However, the HCP notified me that they couldn’t guarantee conclusive tests for gonorrhea and HIV which freaked me out. I was too anxious to hear when it would be conclusive and therefore I’ve been having everything from night sweats to chills, to imagining syphilis ulcers in my mouth and throat and I’m at a loss.

You describe a nearly zero risk exposure for HIV and other STis. It is unlikely a partner like yours has an active transmissible infection, especially orally; oral sex is low risk, even if she had an oral infection; condoms are excellent protection for vaginal sex; and absence of symptoms, even before you were tested, added to the very low likelihood you acquired any STI. Had you asked earlier, our advice on this forum would have been you didn't even need testing.

Despite your HCP's advice, your negative test results were conclusive and you can rely on them. When we now add your negative test results to the low chance even before testing, I would judge the probability you caught any of the infections tested at under one chance in many millions. As for your HCP's comment, it is technically true that almost no lab test is 100% certain; human biology and the technology of testing are too complex. However, this really reflects a philosophical approach to patient counseling rather than a practical one that works in the real world. The fact is that the tests you had -- and the combination of those results plus the low risk described above -- make it certain you do not have gonorrhea, chlamydia, syphilis or HIV.

Technically, the HIV and syphilis results were a bit early; they are conclusive after 6 weeks, but nearly so (99% or thereabouts) at 5 weeks. You could consider repeating them at 6 weeks or more, but that would be almost entirely for reassurance, not because there is any realistic risk you have either infection.

As for your symptoms, your description -- especially use of "imagining" -- suggests you don't really have any of the symptoms you list. If you do, of course see a doctor in person about them.

So do your best to mellow out. You were at little if any STI/HIV risk to start and the evidence in virtually conclusive you are not infected and could not have transmitted anything to your wife. All is well. But go ahead and have additional HIV and syphilis blood tests if those negative results will further help you stop worrying.

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

HHH, MD

I can however not shake the feeling that something is waiting to suddenly pop up, especially Syphilis symptoms. I’ve read that late seroconversion can happen and symptoms may occur up until six months after exposition?! Would testing at 5-6 weeks definitely be conclusive beyond any doubt then and I don’t need to worry about symptoms after that test? If you could elaborate a bit on this to ease my mind I’d be very appreciative.

I’m abstaining from sex with my wife to not jeopardize the pregnancy. But I read that syphilis can be transmitted from kisses? I’d rather be HIV positive than have Syphilis and spread it to my wife and the baby and take the consequences of my own actions…

Follow my advice to test again 6 weeks or more after the exposure. The results will be negative. I will be happy to comment one more time if you'd like to wait for those results and let me know what they are. I won't have anything more to say until then. In the meantime, try to think just a little bit objectively. And trust our advice on this:  in the 20 years of this and our preceding forum, with thousands of questions like yours, when we predicted a questioner would test negative for either HIV or syphilis, we have never been wrong. You're not going be the one who spoils that record!

One thing I really need to ask; I noticed something under my right eyelid on day 28, and had that checked out recently at primary care. The doctor noticed what she described as a blister/ulcer of 2mm under my top right eyelid and said she’s never seen anything like it. I was referred to the eye specialist and have an examination on 18th of august. I have read that syphilis chancres may manifest in the eyelid and I am not sure if my eyes were contaminated. Is this something you’ve seen occur before?

Would a syphilis blood test have detected an infection in the case of a syphilis chancre in my eyelid (28D) on the 35th day, 7 days after I noticed it?

I realize this is the final question and will gladly pay for further questions.

I strongly suggest you contact the ophthalmologist immediately and tell that office that you are worried about herpes very close to your eye. Either simplex or zoster can be very dangerous to the eye and they probably will agree to see you very quickly, without waiting another several days. If it's herpes, it should be tested as promptly as possible (the sooner the better for accurate diagnosis) and treatment started immediately, without waiting for a test result.

This probably has nothing to do with the sexual exposure you have been concerned about, but it could be a very urgent situation.

That completes the two follow-up exchanges included with each question and normally would end this thread. But I'll leave it open for now -- still hoping to hear about a syphilis blood test at 6 weeks, and about follow-up on your eye lesion. Good luck.

I just had test results back taken on day 55-56 (8 weeks) after exposure. All negative once again. I was especially concerned about chlamydia and gonorrhea since I overurinated during my first test, but those fears have been quelled, as well as the conclusive post 6 weeks HIV test.

The only thing I’d like to dwell (sorry) about is on the syphilis results. Whilst a negative test at 8 weeks is reassuring, there still are guidelines of 90 days being conclusive. The nurse at the clinic reiterated this as well. Would you be able to go into detail about why a negative test after 6 weeks were deemed conclusive by yourself?

Thank you once again for the help during stressful times - I realize this may be our final interaction in this thread.

As you expected, that concludes this thread. Thanks for the thanks -- I'm glad to have helped.