[Question #11560] Syphilis Concern - Please Help

13 months ago

I am a girl. I blacked out at a bar for 30 minutes 48 days ago. I am assuming the worst at this point due to my symptoms. I got sick with a head cold 5 days later where I could feel one tonsil and sore throat. I went to the doctor and got prescribed a z-pack of azithromycin & steroids. The z-pack did cure my cold but not tonsil. 20 days after event I tested for all stds and came back negative. Got a cold after taking steroid on day 20. Fever, chills, tonsil is still swollen & sore throat was still there. Ended up going to doctor day after (21 days after original event) & got 500 mg amoxicillin 2/day for 10 days (ending 31 days after original event). Sore throat began to go away but came back 7 days after taking amoxicillin. I went in again and got a throat culture for Chlamydia & Gonorrhea and general one. I was prescribed 7 days doxy 100 ml 2/day but stopped on day 4 when I got my negative results back. Still have a sore throat and swollen tonsil so went into the doctor 33 days after original event and got levofloxacin for 10 days 500 mg 1 /day. I took a full 10 panel std test (4th gen HIV) 44 days after event and all negative. Still have swollen tonsil and sore throat. I got a new ulcer looking thing in my mouth two days ago. I have a significant other and have not slept with him in 7 days but I did sleep with him after I found out I was clear of HIV. I have been negative for syphilis on all my tests with the latest being 7, 4 and 1 days ago. I am wondering if I can pass it to him if I am showing negative on all these tests or did the antibiotics make it to where I can still pass it to him without being positive on tests? If I have not slept with him for 10 days and have had negative results during that time can I take the penicillin on day 10 and not have to worry about passing it to him?

H. Hunter Handsfield, MD

13 months ago

Welcome to the forum. I think I can help.

No STI causes sore throat or the other symptoms you describe. In addition, the treatments you had would have cured (or aborted early infection) gonorrhea, chlamydia, and syphilis: at this point there is no possibility you have any of these. And your negative tests are conclusive at 44 days for all the infections included in the test panel.

Almost certainly you have had an upper respiratory viral infection. Conceivably you caught it during your black-out, or from any other non-intimate contact with an infected person. The various antibiotics aren't helping simply because no antibiotic has any effect against any viral infection.

As for the "ulcer like thing", for the reasons above it cannot be syphilis; and it came on much too long after the blackout to be due to any infection caught at that time.

I'm glad to hear you tested negative for HIV as well. Nothing in your story would have made me worried about HIV, but in any case the negative test result is conclusive.

I am very confident you have neither HIV nor any other STI. Please don't worry about it --and stop testing! You cannot infect your partner with any of these things -- except maybe a prolonged respiratory virus.

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

HHH, MD

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13 months ago

From your forum, I was under the impression that I did not take a high enough dose of azithromycin to abort since it was just a z pack with the highest I took in 24 hours was maybe 750 mg. Also that amoxicillin can be resistant to syphilis. And I only took doxy for 4 days starting at day 27. Can you clarity if you still think that I aborted or cured syphilis? If it did not cure or abort with these doses/length of these antibiotics, I am wondering if I can pass it to him if I am showing negative on all these tests or did the antibiotics make it to where I can still pass it to him without being positive on tests? If I have not slept with him for 10 days and have had negative results during that time can I take the penicillin on day 10 and not have to worry about passing it to him? Also, If it didn't cure it, would my tests still be conclusive?

Another side question, I was diagnosed with HSV2 about 4 years ago IGG of 1.2. I have taken 4 HSV2 tests with this event and they have all come back negative. Perhaps a false + HOWEVER, I had all the symptoms. I was in excuriating pain in my genitals. I had a similar break out a couple months later. Do you know why I keep getting negative HSV2 tests?

H. Hunter Handsfield, MD

13 months ago

I think you're confusing advice about treating active syphilis versus preventing or aborting infection after exposure. You are correct about azithromycin: in fact there is NO dose that works against syphilis. Recent research (led by my forum colleague, Dr. Hook) shows that nearly 100% of syphilis bacteria in the US are resistant to it. But wrong about amoxicillin, which is highly active against syphilis: the doxycycline and amoxicillin you took both were 100% effective in aborting or preventing syphilis if you were exposed. Also, there is no such thing as antibiotics turning syphilis blood tests negative without curing it. Your negative tests are 100% proof you do not have syphilis (and probably never did); you cannot infect your partner and do not need penicillin or any other treatment.

You might not have HSV2 after all. With the main HSV IgG tests in use in the US, a barely positive result like 1.2 often is false; the HSV2 IgG test is not conclusive until and unless the index value is 3.5 or higher. Your subsequent negative tests probably are accurate. "Pain in the genitals" (without blisters/sores) is not typical for herpes. However, if your outbreaks really are typical blisters that become open sores, herpes still is likely despite the negative blood tests. You should work out a plan with your doctor to be seen immediately (within a day or two) of your next apparent outbreak so it can be tested for HSV itself. PCR testing for the virus, if positive, is a lot better than relying on the blood tests. (Or you can speak with your doctor about having a Western blot test -- the gold standard used to confirm uncertain IgG test results. If your doctor isn't familiar, or if you'd just like to save time, post a new question on this forum, using the Herpes category. Our colleague Terri Warren will respond, and she is in an excellent position to arrange for WB testing when needed -- and also would be happy to evaluate your symptoms and other information that might be helpful.)

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13 months ago

Thanks for some peace of mind. Final questions: Would the amoxicillin alone that I took be able to cure/prevent syphilis? If I would have had a chancre and started amoxicillin that same day would my test ever have turned positive at some point or remained negative? Can you give me some statistics on how rare sexually transmitting molluscum contagious is? Thank you for your help!

13 months ago

I feel like I’m going crazy. I just looked at my throat and my uvula has a white patch that is surrounded by red indents. I can’t tell which color is normal for it therefore I can’t decipher if I have red indents or a white patch or both. I went to a doctor and they have no idea what it is so I’m being referred to an ENT. Would the amoxicillin at 500 mg 2/day starting at day 21 after the event cured or prevented syphilis for sure? These problems seem to be all occurring around 16-17 days after I got off the amoxicillin

13 months ago

Also this doesn’t sound like any other STI?

H. Hunter Handsfield, MD

13 months ago

You're seriously overthinking this. Your blood test results PROVE you do not have syphilis and never did. As I said above, either the amoxicillin or doxycycline (alone) would have aborted or treated syphilis if you were exposed. And why in heaven's name do you imagine you were sexually active (or assaulted?) during your blackout? I see no plausible STI/HIV risk here.

Anything occurring 2+ weeks after completing amoxicillin cannot be syphilis; very unlikely to be gonorrhea; and chlamydia would have been prevented or cured with doxycycline.

Your throat/oral issues are not due to any STI. There are none that cause such symptoms! Do your best to put aside your uncertainties or anxieties about your blackout, and try to think objectively about your symptoms. Garden variety respiratory viruses are a hundred times more common (maybe more) than any other possible explanation. Also do your best to believe, understand and accept the reasoned, science based evaluation and advice I've tried to give you.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. If your symptoms continue, keep working with your personal doctor. But PLEASE disregard syphilis and all other STIs; and have no more tests. Best wishes and stay safe.

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Terri Warren, RN, Nurse Practitioner

13 months ago

I would happily talk with you for a minute about HSV testing. Dr. Handsfield is correct - there is actually an 85% chance that your IgG test for HSV 2 is a false positive (which is why you are probably now getting negatives on future tests). I would recommend that you consider getting a herpes western blot for confirmation. It is only done at the University of Washington in the US but samples can be shipped there from virtually anywhere. And remember, when Dr. Handsfield talks about PCR testing, that is PCR swabbing from a lesion, not PCR blood testing; often clinicians get those two mixed up. If you need help with the western blot and your own health care provider isn't familiar with western blotting, you can visit my website at westoverheights.com.

Terri Warren

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