I asked a question 4 months ago about a negative 4th generation combi test After body to body message, next week I am going to test for Syphilis and I would like to ask some questions:

1-in the past 3 years I had protected sex with more than 20 Eastern European sex workers, never had unprotected sex and never had oral sex or kissing, what is the likelihood of testing positive with syphilis test?

2-if I tested positive with syphilis test does that mean I should retest my HIV test although I had two negative tests after 4 months with combi test, because I read in this forum that most people with syphilis have HIV too.( I am heterosexual man)

3- I was thinking of taking penicillin injection without testing because here in the Middle East I will be in big trouble if I tested positive for any std but I read that it’s very dangerous to take penicillin if you have undiagnosed neurosyphilis, what do you think?

1. In discussion the question posted 4 months ago, you planned to test for syphilis at that time. Apparently still not done? If done and negative, the result is reliable. If not yet done, I agree it is reasonable to test now. Having had only protected vaginal sex and with apparently no symptoms to suggest syphilis (slowly healing penile sore, unexplained skin rash, etc), it is very unlikely you have syphilis. You can expect a negative result.

2. There is no reason to test again for HIV. Your previous negative tests cannot change if you have not been reexposed in the meantime. Having a syphilis test makes no difference. (Of course you are free to be retested for HIV if you like -- but I see no reason for it.)

3. You should not be treated with penicillin (or anything else) on account of your concern about syphilis, unless you test positive. A negative standard blood test will prove you do not have neurosyphilis or any other type of syphilis.

Given your anxieties about this, I suggest you arrange for a syphilis blood test right away, then return to the forum and let me know the result. I will have no further comments or advice until then, however. Threads are closed after 4 weeks, so do it before then. In the meantime, let me know if anything isn't clear.

HHH, MD

1)how long Syphilis is contagious , USA guidelines say after 1 years the infection can’t be spread.The uk guidelines say that it can’t be spread after 2 years, which one is true?

2) you are always telling heterosexual males that syphilis is very rare in heterosexual exposure, why you are telling me that I must test now knowing that I am heterosexual male

2) Risk level is not the only basis for our advice for testing, whether for syphilis, HIV, or other STIs. Sometimes we even advise testing when the risk is zero, if the negative result will be reassuring to the user. You're the one expressing concern about syphilis, with an obvious desire to know for sure you don't have it. With 20 sex worker partners, clearly you at some risk of syphilis; as long as the risk isn't zero, a blood test is the only way to know for certain. It remains a puzzle to me why you didn't do it after your previous forum discussion four months ago.

In most industrialized countries, syphilis is less common in heterosexuals than in men who have sex with men, but heterosexual transmission certainly isn't rare. In most of the world it's primarily transmitted between men and women.

As you know, forum questions are open for two follow-up comments and replies, or for 4 weeks, whichever comes first. If you get tested and would like to let me know the result, I'll be happy to comment one last time. I won't have any further advice until then. 

You do not need any HIV test if your HIV AgAb (combo) test was done more than 6 weeks after the last possible exposure.

I have no way of knowing why you remain so fearful despite the repeated, reasoned, science based reassurance you have had on this forum and probably from your own doctors(s) as well. But a "psychological problem" seems likely. And whenever someone suspects their own problem is psychological, usually they are right. Seeing a counselor would be wise -- even if it confirms the problem isn't psychological after all.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your third question and the second on your HIV fears and test results, it will have to be your last one; future questions on along these lines may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

Sorry again for the delayed final reply. I hope the discussion has been helpful. Best wishes and stay safe.