[Question #10918] Worried about possible exposure

18 months ago

Hello,

I had protected sexual intercourse with a transsexual sexworker on 05/02/2023.

Because of my OCD I had worries about possible exposure to std's, especially syphilis. So I asked her to do a test, which she agreed on. She did the test on 14/02/2023, so 9 days after we had intercourse. ( I know its too soon, but I wanted to make sure she didnt have a anything at the moment)

On her exam that she showed me the VDRL / RPR is negative. But the CLIA test ( I think its for antibodies?) has a higher value then the reference value ( the clia value is 2,4 and the reference value is 0.9). The sidenote on the exam sais: limit value, not very signicative

I have been tested multiple times the months after the event and everything was always negative. But here are my questions:

1) My worst fear is to have been in contact with a syphilis chancre. Based on this test, do you think the sexworker had an active syphilis sore when we had sex. I showed the picture of her test results to my doctor and he told me there was no active syphilis because vdrl/rpr was negative, but there could have been a past infection years ago. I have read that the vdrl / rpr becomes positive a few days after the appearance of a chancre. So does that mean that there was no active syphilis present on the 5th of february since vdrl/rpr was negative the 14th of february? was it indeed a past infection?

2) I fear this because my ocd tells me its somehow possible to spread this germs to other people and infect them. For example: I believe that maybe I touched the chancre and then touch my belt. So I can infect other people with it if they would touch my belt. Or maybe the germs get in between my belt and my pants and somehow survive? Is this possible?

Thanks in advance

H. Hunter Handsfield, MD

18 months ago

Welcome back to the forum. FYI, I scanned your four previous threads 5 years ago. Thank you for your continued confidence in our advice. As you recognize, the main health issue in evidence (again) is your OCD. That said, I'm happy about the five year gap, which suggests that maybe you're in reasonably good control of your OCD.

At this point, 9 months after the exposure, you needn't worry at all about syphilis or any other STD. First, your partner's negative syphilis blood test 9 days after exposure is 100% proof you could not have acquired syphilis. Syphilis does not become transmissible sooner than 3-4 weeks after exposure, or before the blood test is positive -- so she didn't have transmissible syphilis at the time you had sex with her. And your negative RPR and/or VDRL results are proof you do not have active syphilis. A positive T. pallidum-specific antibody test (like CLIA) could indeed indicate either past (cured) syphilis or just a false positive result, which is quite common with such tests.

1) Those comments address this question. There is no realistic possibility your partner had infectious syphilis during your contact; but if somehow she did, it is clear you were not infected. However, perhaps you would like to tell me exactly the wording of your CLIA test result. If done more than once, let me know the exact numerical values and written report of every test you had. If necessary, another blood test can be done to sort out whether your CLIA indicates past syphilis or a false positive result. If all or most of your past sexual experiences were similar to those described here or in your questions 5 years ago, I would predict false positive.

2) Even people with active, infectious syphilis with chancres or other open sores never transmit the infection other than by sex. It doesn't happen. There is no possibility you are infectious to persons around you or ever were.

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

HHH, MD

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18 months ago

Thanks doctor,

I try to manage and overcome my somewhat irrational worries, but sometimes I give in to them and I need assurance.. I am also on medication, which helps.

Just to be clear: This negative VDRL/RPR test combined with the CLIA test which had a higher value is from the screenshot she send to me. So not my test. I did VDRL/RPR which were always negative.

So am I right to say that at the time I had sexual intercourse with her, the negative vdrl/rpr 9 days later proves she had no active syphilis when we were intimate?

If she had a new infection with a chancre at the time we had sex, the vdrl/rpr would be positive?

Bytheway I texted her a few weeks ago and she also told me she wasn't infected with anything last year, but my mind keeps looking for possible worst case scenarios.

Thanks for your answer

H. Hunter Handsfield, MD

18 months ago

Your description of the CLIA test results still isn't clear. It showed a "higher value" compared to what other value? What exactly did the screenshot show.

"So I am right to say...?" Yes, all correct.

Even the "possible worst case scenarios" add up to no possibility you caught syphilis during the exposure you are concerned about.

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18 months ago

Yes, so the screenshot has 2 tables:

Cardiolipide RPR VDRl <1 with reference value <1

Tot. antibodies (CLIA) 2.4 with reference value of 0.9 (remarque: limit value, not very signicative)

Its in french, but thats also how my doctor explained it.

H. Hunter Handsfield, MD

18 months ago

Thanks for the additional information. It appears the lab (apparently in France or other Francophone country) uses terminology that I'm not familiar with. From this limited information, it seems your CLIA is positive. As discussed above, I strongly suspect it's false positive. However, I cannot rule out the possibility you had syphilis in the past, now inactive or treated and cured. An additional T. pallidum antibody test can sort this out. Ask your doctor about having a TPPA, TPHA, MHA-TP, or FTA-ABS test. Probably it will be negative, in which case it will mean you never had syphilis and your CLIA result is false positive. You might show this statement to you doctor and discuss it with him.

That usually would conclude this thread, but let me know if you have any final comments or concerns.

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18 months ago

Hello Doctor,

I think there is misunderstanding. I said these results were not mine, but these were the test results from the sexworker I slept with that she showed me via the screenshot I asked her to take of her test results (she took this test 9 days after we had intercourse)

I only wanted to know, since her vdrl/rpr was negative 9 days after we had sex, there was no active syphilis sore present on her body at the night we had intercourse.

Sorry for the confusion

H. Hunter Handsfield, MD

18 months ago

Thanks for this very important correction: Indeed I thought you were describing your own results. My bad!

The test interpretation is the same for your sex worker partner: she may or not have had syphilis in the past, but for sure she doesn't have it now and did not have a transmissible syphilis at the time of your contact with her. You were at zero risk of syphilis from that event.

That concludes this thread. I hope the discussion has been helpful in allowing you to move on with no further worry about it. Best wishes and stay safe.

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