[Question #11190] Syphillis

16 months ago

Hi doctor hope you are well

About 5/6 years ago

I had protected vagina sex and unprotected oral with a csw in morroco

Also had unprotected oral from another csw a few days later

I've never tested as felt it was low risk

Would like advice if this is something to be worried about

And a few qs if you don't mind

Q1 Would a follictus rash that occurred 6/8 months after exposure and lasted 4 months be linked to syphills, I.e can a syphillis rash start 6/7 months after or is it generally once the chancre is healing

Q2 And for a few years I've also suffered with dyshidrotic eczema of the fingers last 2/ 3 years

Q3 how common is getting a rash on palms and soles of feet if a syphilis rash develops as I never noticed no rash on my palms

Many thanks

Edward W. Hook M.D.

16 months ago

Welcome to the Forum. Thanks for your implied confidence in our service. I'll be gad to comment. The exposures that you describe were very low risk. In general STIs are relatively rare in Morocco, even among commercial sex workers, your genital exposure was condom protected and acquistion of syphilis from receipt of oral sex is also uncommon. Finally, even if one of your partners had syphilis, most single exposures do not lead to infection. I would not be worried.

In response to your specific questions:

The rash is syphilis is highly variable and can mimic almost any other dermatologic process. A syphilis rash could certainly appear 6-8 months after an exposure that led to infection

Q2 And for a few years I've also suffered with dyshidrotic eczema of the fingers last 2/ 3 years

See above

Q3 how common is getting a rash on palms and soles of feet if a syphilis rash develops as I never noticed no rash on my palms

Not everyone who acquires syphilis develops a rash on the hands or soles of their feet. When they do, the rash can be missed

As I said above, your risk for syphilis from the exposures you describe is quite low. I cannot however guarantee you that you did not acquire syphilis. Fortunately, syphilis blood tests are widely available and accurate. If you had acquired syphilis from the exposure you describe, a blood test would show it. Given your current concerns, you may wish to get a syphilis blood test. I anticipate that if you do, it will show that you did not acquire syphilis. EWH

---

16 months ago

Thank you Dr hook

I have just ordered a home test from amazon Igg/igm test

Would this test give me an accurate result? Or are these unreliable

A few follow ups qs if I cab please

Q1 how long would it take a syphillis rash to resolve? Is 4 months (could have been more than 4 months) on the unusual side?

Q2 I am circumcised and I can remember after the exposure I did not notice a chancre (tho I was not checking) and did not feel any swollen inigual lymph nodes

Would it have been unusual for me to miss it? Maybe it was on underside on head?

And even if I was not checking for lymph nodes, would I have felt them if they were there, I.e just sleeping on my side, putting on my shoes etc, what I'm trying to say is surely swollen lymph nodes with regards to inigual area would have caused me some discomfort for me to become aware of a problem if they were swollen?

Q3 if a chancre heals is the risk of infection low after to others? Or does in secondary syphillis there are other lesions around penis that may be transmissible?

Q4 I mentioned dyshidrosis this started like 2 years after exposure, and was on and off for 4 years then resolved, I thought with syphillis after initial rash there are no other symptoms for a few years?

Thank you

Edward W. Hook M.D.

16 months ago

Laboratory based tests are preferable to home tests.

Your follow-ups betray your anxiety and in no way change my opinion of advice. Brief answers:

Q1 how long would it take a syphillis rash to resolve? Is 4 months (could have been more than 4 months) on the unusual side?

Syphilis is a highly variable disease but it would be decidedly unusual for the rash of secondary syphilis to last 4 months

Q2 I am circumcised and I can remember after the exposure I did not notice a chancre (tho I was not checking) and did not feel any swollen inigual lymph nodes

Would it have been unusual for me to miss it? Maybe it was on underside on head?

Yes, it would be unusual for you not to notice a penile lesion. Testing for lymph nodes is best left to a health care provider. Everyone has lymph nodes that can be felt and other body parts that can be mistaken for lymph nodes. Even when you can feel lymph nodes that is not necessarily abnormal.

Q3 if a chancre heals is the risk of infection low after to others? Or does in secondary syphillis there are other lesions around penis that may be transmissible?

Syphilis is transmitted by DIRECT contact with lesions. This includes the lesions of secondary syphilis

I am confident that your dyshidrotis is not due to syphilis

Please don't worry. EWH

---

Edward W. Hook M.D.

16 months ago

I closed your additional post as it was unnecessary. We provide up to 3 responses to each client's questions. I will request that the chare for your unnecessary, further question to be refunded

The two RPRs you saw are essentially equal. In both, with a negative RPR, there is no need for further "reflex" testing. With a negative RPR you can be confident you did not acquire syphilis from the virtually no risk encounter you described.

I hope you will now be able to move forward without further unwarranted worry. EWH

---

Edward W. Hook M.D.

16 months ago

In addition, it is inappropriate to ask further questions using a different user name. Please DO NOT do this. EWH---