[Question #11091] Sysphillis and Doxy Pep

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17 months ago
Thank you doctors for this service. I have been in a bit of an anxious state for the past 2 months. 

Timeline as follows. 

Jan 19th received and gave unprotected oral to MSM no more than 5 min each way. This was totally anonymous and I do not know status

Jan 21st by noon started a 7 day course of doxycycline and took 2 500mg cipro to prevent any possible infections 

February 26 started to notice testicular pain in both testicles as well as frequent urination and back and stomach discomfort. Tested for all urine based STDs all negative. Started Bactrim for 14 days. 

Felt better on day 5. 2.5 weeks later symptoms returned and I noticed a couple small red and purple blemishes on the corona of my penis 1mm or smaller in size. Was proscribed 10 more days of bactrim and sent to urologist. Appointment pending. 

I am currently freaking out. I was under the impression that the doxycycline I took had a 100% success at aborting syphillis infections and infections are rare from oral exposure even in MSM. 

I wonder if these marks are showing now because the antibiotics just suppressed syphillis and all my symptoms are to do that. I am currently on the way to get tested now. Please help! 
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17 months ago
Just completed testing. Feeling a little bit more relaxed. I also should mention the start of the prostatitis symptoms started during a Covid infection. They said it could be due to Covid but they wanted to put me on the bactrim just in case I had a secondary bacterial infection. No marks or anything noted until the start of week 8 from exposure. 
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thank you for your question.

There's no reason to be "freaking out" on account of your symptoms. It is true that doxycycline, in the nose you took, is 100% effective in preventing syphils when taken soon after exposure. Oral sex indeed carries risks for syphilis, especially for sex with male partners, but doxycycline for sure prevented it; and your symptoms are not particularly suggestive of syphilis anyway. Don't assume than a penile rash implies STD; usually it does not. (I have a "Genital Dermatology Atlas". As the title suggests, it is filled with photos and brief discussions of genital skin conditions. Of its 300 pages, all STDs are covered in 15 pages -- an indicator of how infrequently such problems are due to STD.) In addition, a penile rash alone is exceedingly unlikely to be the only symptom of syphilis. Testicular pain and prostatitis aren't syphilis symptoms at all.

There is no such thing as antibiotics suppressing syphilis to make testing negative while the infection persists. If infection is present, blood tests are universally positive. In other words, antibiotics can make syphilis tests negative only by curing the infection. (Ciprofloxacin and Bactrim are ineffective against syphilis but as noted, doxycycline is 100% reliable in curing or preventing it.)

I'm also glad to see your follow-up comments and happy to hear you're now less freaked out. At this point, it seems all is well -- although if your penile skin continues to appear abnormal to you, you might consider seeing a dermatologist. But it doesn't sound worrisome, and certainly isn't syphilis.

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

HHH, MD
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17 months ago
Thank you so much Dr Handsfield. You are Dr. Hooks expertise and time and attention are a huge help.

So just to recap. Doxy is 100% effective in that dose so I could theoretically move on and have sex with my partner unprotected without issue even without the testing I did today? No need to wait on results?

Just out of my own curiosity, bactrim being ineffective on let’s say syphillis wouldn’t delay any symptoms? The syphillis would just power through like nothing was happening? I’ve always been curious about this. In regards to syphillis it’s been the one question that made me so anxious. 

Do to my anxiety induced research, I honestly think these red marks might be yeast from the intense antibiotics I’ve been on for 2 months. I just needed confirmation from you and a negative test so I can stop thinking about this. 

Again, thank you so so much. I would send you flowers, but since that’s not an option I will be making a donation to the aids foundation in you and the teams honor. 
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17 months ago
Sorry for the double message again. 

In relation to the bactrim question and the timeline. I mean, if normal symptom onset is 2 to 4 weeks for an infection, would an ineffective antibiotic push incubation and symptom progression at all? I guess it really depends on the microbiological mechanisms the antibiotic uses to kill and this probably varies between antibiotics, but I’m curious to get your opinion. 

Thanks again and all the best! 
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H. Hunter Handsfield, MD
17 months ago
"Doxy is 100% effective in that dose so I could theoretically move on and have sex with my partner unprotected...." Correct.

"bactrim being ineffective on let’s say syphilis wouldn’t delay any symptoms?" As I said, it is completely ineffective -- the syphilis bacteria is no more affected by Bactrim than by water. It can have no effect. I also said that NO antibiotics merely delay or alter test results, except for those that make tests negative by curing the infection. There is no such thing as partial suppression with negative test results despite persisting infection. It doesn't happen.

"these red marks might be yeast...." I can't judge the cause, but the timing seems consistent with that explanation.

Your follow-up Bactrim question: Answered above, this cannot happen. You are exactly correct that "it really depends on the microbiological mechanisms the antibiotic uses to kill and this probably varies between antibiotics."

Thank you for considering a charitable donation. I suggest the sponsor of this forum, the American Sexual Health Association. It's the nation's premier private nonprofit agency in support of sexual health, especially in regard to STDs. Go to www.ashasexualhealth.org and look for the donate button. (Full disclosure, Dr. Hook and I are former ASHA board members.)
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17 months ago
I am extremely relieved and happy to report I have tested non-reactive on the syphillis rpr test. 

Again, thank you so much for all that you do for the community. You all are hero’s and it’s so rare to get this detailed and expert advice in any subject much less one that is so difficult for people to deal with. Your advise really helped me yesterday and I can’t that you enough. 
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H. Hunter Handsfield, MD
17 months ago
I'm glad to hear of your negative test result, but of course not surprised!

Thanks for the thanks and for your kind words. Perhaps you'd like to consider making a donation to the American Sexual Health Association, the forum sponsor and the country's premier private nonprofit agency in support of sexual health, especially in relation to STDs. There's a donate link on the website (www.ashasexualhealth.org). (Full disclosure, Dr. Hook and I are former members of ASHA's board of directors.)

Thanks again!
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