[Question #12021] Oral Syphilis Risk
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10 months ago
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Hello,
8 days ago I performed unprotected oral to a WM in his mid 40s for approx 2 minutes. He insisted he was tested 2 weeks ago and No lesions were noticed however the room was darker. I was traveling to an area that I've since looked up that has a population of 300,000 and in 2023 had a rate of syphilis of 28.77 per 100,000 if I am reading stats right.
After the exposure I was worried and had 3 pills of Amoxicillin 500 mg that I took once a day.
This morning I noticed a small bump on the inside of my lower lip. Its mostly red and if I pull it tight I can see possibly yellow but really not for sure. I am worried this might be a syphilis chancre but it seems very early?
What would you suggest?
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Edward W. Hook M.D.
10 months ago
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Welcome to the Forum. Thanks for your questions. I'll be glad to comment. The exposure you describe was low risk. Most people do not have syphilis, most single exposures to persons with syphilis do not lead to infection, and your partner told you that he had been tested and was negative (most people tell the truth). Finally, taking 1500 mg of amoxicillin soon after your exposure, while not recommended, would have prevented you from acquiring syphilis. For these reason, while the timing is compatible with the appearance of a recently acquired syphilis lesion (slightly in the early side but compatible), it is most unlikely that the lesion you have noticed on your lip is syphilis.
It the lesion you see is syphilis it will go on to form an ulcer in the next 2-3 days. I doubt that this will happen, providing still more evidence that the lesion you have noticed is not syphilis.
Finally, if you want to prove that the lesion you have seen is not syphilis, test in 2-3 days. If this were syphilis the test will be positive. I am confident however that when you test, the test will be negative, proving that it is not due to syphilis.
I hope that this information and perspective is helpful. EWH
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10 months ago
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Thank you for the fast and reassuring response, I will keep a close eye on this the next few days it does not seem to be changing much over the course of this day.
As far as oral being a form of transmission I'm confused by what I'm seeing online on different health websites. Some say 30% of new syphilis cases are from oral exposure only, that contributed to my fear over this. I had not performed oral in years and reading online it is being presented frequently as if it's out breaking all over. Is that not really the case? What is the actual rate that you would say comes from oral only exposure?
For testing, will the amoxicillin cause issues with the result testing close to the 3 days I took the pills?
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Edward W. Hook M.D.
10 months ago
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The information on the Internet regarding how often oral sex leads to Syphilis is overstated as much of what is found on the Internet Internet. I would estimate that less than 5% of recently acquired syphilis, and perhaps far less, is the result of performing oral sex on an infected partner.
As I mentioned above, the amoxicillin that you took would prevent the development of syphilis. Tests for syphilis will remain negative. While testing sooner will prove that the lesion on your lip that you noticed is not Syphilis, conclusive testing for syphilis can be performed anytime more than six weeks following ear exposure.
EWH
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10 months ago
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Thank you, and for my final question am I correct that a lesion from syphilis would not act the same as a cold sore? I get those from time to time, though not normally in this area. But my cold sores typically fill with pus then burst. A syphilis sore would not act like this correct? My feeling is what I have coming on may be a cold sore, maybe related to the oral exposure?
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Edward W. Hook M.D.
10 months ago
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Final response. This is a repetitive question. Please see my response above. What you describe does not suggest syphilis.
End of thread. EWH
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