[Question #11407] 6 weeks conclusive?

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14 months ago
I have recently discovered so many details from your previous posts in medhelp and at this forum. My contact was at 2 April with a sex worker rather old I would say around 55 years (female)  and I am male. I did not have vaginal or anal intercourse. She just licked me shaft area and my testicles for some 2-3 minutes and maybe even the tip of my penis if that does make any difference. She proceeded to rub it in her chest while i ejaculated. All that time she gave me handjob.I went to a public hospital and they prescribed my blood test for hiv (4th gen with p24), heb b,c and syphillis using vdrl and tpha (which came negative <1/80) . I was also prescribed,although I asked them if it was necessary given my contact , a real time pcr test with limit of detection that was take sticking a swab inside my urethra which tested me for ghono Chlamydia hsv and syphillis. Everything was done at 6 weeks from this encounter and everything came negative (I learner that i have 50,5 miu/ml  antibodies from my childhood vaccination guess I do not have to worry about hep b either? ). During all this time I used condom only with my current partner just to be sure. When the test came back negative I felt relieved and decided to proceeded some condomless sex with my partner (only oral because I am afraid of unwanted pregnancy). The problem that I have is regarding syphillis because I get conflicting information about the test timeline. The cdc says 3 months conclusive, the lab that i tested says 10 days(obvious not true) and the hospital says at about a month. I have also read in your other posts different timelines that you also have advised about the conclusiveness of the syphillis test. Should I be worried ? Can I proceed with the slightest worry of having unprotected sex with my partner which knows nothing about it? No symptoms of anything these weeks now I am on the 9th week..

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14 months ago
I live in Greece if that matters at all because syphillis are on the rise as I have read
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Edward W. Hook M.D.
14 months ago
Welcome to our Forum and thanks for your questions, as well as for your confidence in our service.  I'll be glad to comment.  

The exposure you describe did not put you at risk for any STI.  Most commercial sex workers do not have STIs and even when a partner has an STI, most single risky exposures do not lead to infection.  Your exposures however were not risky- receipt of masturbation, having a partner rub their body on yours (this is often referred to as "frottage"), and having your penis and genitals licked without your penis entering your partner's mouth are all considered no risk activities by the WHO, the US CDC, and experts in the field.  The testing you had at 6 weeks reliably confirms that you were not infected.  

You are correct that recommendations for syphilis testing vary.  The CDC's recommendations reflect older belief's and are out of date.  Persons who are going to develop a syphilis lesion do so about 3 weeks after exposure and blood tests typically become positive within 4-6 weeks.  I am confident that you did not acquire any STI you tested for, including syphilis.  I see no need for further testing and no need to avoid unprotected sex with your partner.  You are in the clear.

I hope this information is helpful.  EWH
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14 months ago
I thought that if she had syphillis on the tongue or on the lips it would be possible. This is my main worry as I think for the other sti I am pretty much covered don't you think? Are those pcr test reliable? (Hope they are I paid a great amount of money for them)? Even if there was something in her tongue that I would not be able to identify do you say that I am clear?  Are all those tests enough even for the peace of my mind? Regarding hepatitis are my antibodies enough to not acquire it? Please I hope that you Will answer my questions. Sorry for the stupid questions
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Edward W. Hook M.D.
14 months ago
Your follow up questions are a bit repetitive.  As I said above, your test results are conclusive.  The PCR tests are very reliable.  

Even in the very, very unlikely situation that your partner had something on her tongue, your tests prove you were not infected.  

Yes, your hepatitis B antibody levels are protective.

I think you are worrying unnecessarily.  I encourage you to put your fears behind you and move forward without concern.  EWH
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14 months ago
Ok thank you for everything since I have one more question, if you could establish more scientific about the reason that the syphillis data are outdated? I mean isn't in their profit to reduce the testing time? Why do they keep outdated? There is zero possibility for someone to have seroconvertion (antibodies against syphillis) in 70 or 80 days? 
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Edward W. Hook M.D.
14 months ago
The CDC is by nature conservative and slow to change. Obviously, it would be unethical to observe patients known to have been exposed to a partner with syphilis without providing preventative treatment. For that reason basis of my statement regarding confidence at six weeks or even sooner is based on Experience. 

As you know, we provide up to three responses to each clients questions. This will be my final response. I hope the information I have provided has been helpful and will allow you to move forward without concern. EWH.
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14 months ago
Sorry doctor my English are not my first language I didn't get the part about unethical and what you mean exactly, sorry for the inconvenience...
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Edward W. Hook M.D.
14 months ago
By unethical, I was saying that to study how long it takes for syphilis blood tests to become positive cannot be ethically studied because to do so would require observing persons who were exposed to syphilis and needed treatment to be observed without to treatment to find out how long it took for tests to become positive.  As a result, the information I provided was based on clinical observations of persons who came for testing after variable periods of time.

Please believe me, your results are conclusive.

This completes this thread.  EWH
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