[Question #10823] Half-specific half general questions about syphillis
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19 months ago
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In regards to my previous question, I was anally fingered by another man and gave a handjob in July 2022, with no fluids exchanged and tested negative for syphillis after 6 weeks, and presumably 3 months (I don’t know if my clinic got my results but I assume neg regardless bc they didn’t reach out). I am in Ottawa though, so my specific question in regards to my exposure is if I can consider a CMIA test conclusive after 6 weeks, as that’s what they do first in Ontario Canada.
General questions about syphillis: can it be transmitted without any symptoms present? I’m not asking about touching a chancre that the infected person isn’t aware of, I’m asking about someone who doesn’t have any symptoms at all.
Also, on forums here, both dr hook and handsfield mention that all hand to genital contact is considered safe; does that include men with other men? I didn’t have any anal or oral sex with the partner in question. Thank you!
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H. Hunter Handsfield, MD
19 months ago
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Welcome back. I have read your recent discussion with Dr. Hook and agree with his evaluation, conclusions and advice.
As Dr. Hook advised, most experts agree the relatively new T. pallidum specific antibody tests -- CMIA, EIA, etc -- are conclusive after 6 weeks. In your particular situation, you had an exposure that has never been known to transmit syphilis; and lack of symptoms also reduces the likelihood. I would put the chance you have syphilis, considering all these aspects, at well under one chance in several million.
Yes, it certainly is possible to catch syphilis from infected persons who have no symptoms at the time exposure takes place. It happens all the time -- in fact, it is likely that most syphiolis results from contact with infected persons who either have no symptoms at all, or who have ignored subtle symptoms. Often it results from penetration in the presence of internal (vaginal, anal, oral) lesions not recognized by the infected person.
And yes, the absence of known cases of syphilis transmitted by hand-genital contact (or by anal fingering) applies to men having sex with men.
I hope these comments help clarify things for you. Let me know if anything isn't clear.
HHH, MD
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19 months ago
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Thank you for clarifying! My follow ups are as follow then: if I was a patient of your office, would you have recommended any testing at all? And would you recommend I do any further tests, or was my test conclusive in your mind? Finally, would I be okay to have sex regularly with a partner?
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H. Hunter Handsfield, MD
19 months ago
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Looking back at the sexual exposure you described in your previous thread, I would have advised my patient that testing for syphilis (or any other STD) was not necessary from a medical/risk standpoint. But syphilis testing is simple and easy, and I would be happy to order a test for reassurance; resolving anxieties is certainly a valid reason for testing, especially with easy and inexpensive tests. When done at 6 weeks or more, I would say exactly what you have been told: it confirms that you do not have syphilis. I would also have advised from the start that there was no need to hold off on sex with any partner -- that is, you could have been sexually active with other persons immediately after that exposure, with little realistic chance you could infect your regular partner.
If somehow I had personally been in your situation, I would not have been tested and would have continued unprotected sex with my wife without concern.
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19 months ago
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Thank you again! Final follow up, and it may be silly, but again, I did CMIA testing. Would you have also said I’m in the clear after 6 weeks if the first test was a CMIA? I never had an RPR test as far as I can tell for syphillis. Thank you!
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H. Hunter Handsfield, MD
19 months ago
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From above: "As Dr. Hook advised, most experts agree the relatively new T. pallidum specific antibody tests -- CMIA, EIA, etc -- are conclusive after 6 weeks." Same for RPR.
That completes the two follow-up comments included with each question and so ends this thread. I hope the discussion has been helpful.
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