[Question #11315] Syphilis Augmentin and Testing

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15 months ago
Hello Drs and thank you for this site.
I am a mid-fifties male who recently had oral sex with a man of about the same age from Eastern Europe. He performed oral sex on me for about 10 minutes.  I performed on him for about 10 seconds. No ejaculation by either, no sores or fluids visible. I do not know much about his background as we met at a conference.
About 10 days later, and after a lingering cough that started before the exposure, my throat became sore and my doctor prescribed me Augmentin 875/125 2x a day for 10 days. He said he was betting the cough and sore throat were viral in origin but because of my travel he wanted to be cautious in case it was bacterial.
At 35 days after the possible exposure I decided to get a std panel test from Quest in an abundance of caution (I am starting a relationship with a woman after not dating and being essentially celibate for nearly a decade).  All results were negative. 
However, I note that in some of your advice that 6 weeks from a possible exposure is necessary for syphilis testing in particular. So some questions:
1) Would you suggest I re-test for syphilis?
2) Would the Augmentin have cured syphilis anyway?
Thank you

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15 months ago
I should add that it has been 6 months since this happened.  And, no symptoms of any kind.
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H. Hunter Handsfield, MD
15 months ago
Welcome. Thank you for your confidence in our services. I'm happy to address these questions. The bottom line is that you have nothing to worry about in regard to syphilis or any other STI from the exposure described.

I don't think you were worried that your cough and sore throat were due to syphilis or any STI; if so, you were right-- no worries there. I agree with your doctor that you almost certainly had a viral upper respiratory infection -- and although I can't completely disagree with his reasoning about prescribing amoxicillin/clavulanate (Augmentin), I would not have done it, traveling or not. However, it did reduce whatever small STI risk you had from the event 10 days earlier. It definitely would have aborted incubating syphilis if you had been exposed; and prevent or cure most gonorrhea (although absence of urethral discharge and painful urination within 10 days is by itself nearly 100% proof you didn't acquire gonorrhea).

The 6 week interval for syphilis testing doesn't apply when there is no chance of infection. Antibiotics active agains syphilis do not convert positive tests to false negative results. They prevent positive test results by preventing or curing infection in the first place.

Those comments pretty well cover your two questions, but to be explicit:  1) There is no need to retest for syphilis. 2) Yes the treatment would have aborted syphilis, or cure it if it already had taken hold.

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

HHH, MD

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15 months ago
Thank you for your time and consideration.