[Question #1072] Syphilis from received Rimming?

49 months ago
I'm a straight married male.  I went to an Asian massage parlor and unexpectedly received rimming and oral sex.  I let it happen for a couple of minutes and got scared and left.  A couple days later my guilt and anxiety led me to the Urgent Care to get looked at.  The Dr said he doesn't think that incident warranted testing and that the pain in my penis was created in my head because it was too soon to be a symptom. He gave Doxycycline twice a day for 7 days to help ease my mind.  No testing was done.  I only ran the course for 4 maybe 5 days because I had moved on in my head and the pain was gone.  However, it's 2 years after the event and my anxiety has spiked again. I read that syphylis can easily be transmitted in this way if she had a sore on her tongue and that symptoms can be hard to show if the sore is in the anus.  I've had hemorrhoids for years and now I panic that I could have had a sore and never noticed.  Wouldn't it appear on both my penis and anus? Also, I get mad that I never completed the full course of antibiotics.
Am I just anxious or do I need testing?  My anxiety is high because I don't want to blow my family up because I caught syphilis from a bad choice.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome to the forum. Thanks for your question.

I agree with the assessment of the urgent care doctor you saw:  there was no appreciable risk of syphilis from this event, because a) syphilis is very rare in female sex workers (or massage therapists), b) oral-anal contact would not be likely to transmit syphilis even if she had it. Further, even the shorter than recommended course of doxycycline almost certainly would have aborted a syphilis infection if you had been exposed. As for an obvious sore if you had been infected, that doesn't apply:  if you had been infected, the doxycycline treatment probably would have prevented appearance of a visible lesion. As for hemorrhoids, there is no realistic chance that they have anything to do with syphilis or the sexual exposure you are concerned about.

Do you "need" testing? From a strictly medical or risk analysis standpoint, definitely not. However, it is clear that your anxieties about it have persisted for a year, and I have no doubt they will continue regardless of any reassurance I can provide. So for that reason alone, you should be tested. To be honest, I'm somewhat surprised you haven't done it already. As implied, you definitely can expect a negative result. If you go ahead with it, feel free to return with a follow-up comment if you'd like to tell me the result.

I hope this has helped. Best wishes--  HHH, MD

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49 months ago
Dr. HHH,

Thanks for the quick reply.  Just to clarify my anxiety 2 years ago lasted about a week as I was only concerned about the oral sex.  It wasn't until recently that I saw something about syphilis and rimming that brought back these feelings.  Up until recently I had forgotten entirely about the incident.

I understand that this was a low risk encounter but not a no risk encounter.  I think I read on one of yours or Dr. Hooks posts about a similar situation and that the risk was more of a "theoretical" risk and not a proven risk.  Regardless, I know the chances are slim.  In regards to the short dose of doxy I took.  It sounds like you think it probably would have killed the bacteria if it was present.  However, you also say that if it was present it would have prevented the appearance of a visible lesion.  Does this mean I could have acquired it and the small dose of Doxy killed the lesion but it's still in my system?  I only brought up the hemorrhoids for the reason if I had a lesion I would have thought it was a roid.

If you can clear up the Doxy thing than I can move on.  I understand it's a very rare infection and unlikely to happen but tell that to the guy who wins the lotto.  I know that you are at the forefront of STI's and I value your answer tremendously.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
"Does this mean I could have acquired it and the small dose of Doxy killed the lesion but it's still in my system?"  Theoretically possible but unlikely. It is much more probable that even 3-4 days of doxy would have resulted in permanent cure.

You don't have syphilis. But can I prove it without you having a blood test? No. I would bet my house on it, but that's not the same as 100% certainty. I still recommend you be tested, for the reasons above.

Let's end this thread unless and until you are tested and report the result. Otherwise no more comments; and if no report of a test result within a couple of weeks, the thread will be closed at that time.

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49 months ago
Since my incident was within the last 2 years could I have an RPR test done and consider that conclusive?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Yes, conclusive. You can trust your negative RPR result when you get it. In the event is should be positive, almost certainly it will not be from the event described above. 

That completes the two follow-ups and replies included with each question. If your RPR is not negative and you need to post a new question to discuss the result, we'll arrange to reimburse the new posting fee.

I hope this discussion has helped. Best wishes and stay safe.
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