[Question #12280] Syphilis
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8 months ago
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Hello Doctor: I have been seeing a CSW and having protected vaginal sex and unprotected oral sex. My wife recently got some sore on the edge of her lip she says is painless. The sore is irregularly shaped, dark brown, crusty, and had pus in it. It looks more like a cold sore. But I am worried it might be Syphilis. My most recent sexual encounter with the CSW was 15 days ago. I did test negative for Syphilis yesterday, but I know it may be too early to have confirmation that I am really negative. I have not seen any chancres or felt any unusual symptoms on my body to make me think I have contracted Syphilis and transferred it to my wife while kissing her. Please note my wife and I have not had any sex for the past year due to her severe back problems. We only kiss on the lips. Do I need to worry about infecting my wife by kissing her on the lips without having symptoms myself?
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8 months ago
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I forgot to add that I also had French kissing with the CSW.
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H. Hunter Handsfield, MD
8 months ago
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Welcome back to the forum. Thanks for your confidence in our services.
There is no realistic chance you have syphilis or that your wife does, for several reasons. First, assuming you're in the US, the chance your CSW partner has syphilis is extremely low (assuing she is female). Second, the timing is wrong: the chance you have transmissible syphilis with a negative blood test is near zero as well. Third, kissing is a very rare route of transmission of syphilis. Fourth, as you imply yourself, the chance of transmitting syphilis in the absence of symptoms (in this case, a sore or other lesion in your mouth or on the lips) is near zero. Fifth, your description of your wife's lip sore is not suggestive of syphilis; as you suggest, it is more consisttent with a cold sore. (Is she known to have cold sores, i.e. oral herpes?)
For reassurance, you might consider another syphilis blood test in a couple more weeks; a negative result would confirm you don't have it and could not have infected your wife. Or you could discuss the situation with your CSW partner and invite her to be tested (and perhaps pay for it). If she tests negative, you would know immediately you're in the clear.
In the meantime, do your best not to worry. I am very confident neither your nor your wife have syphilis -- and almost certainly not your CSW partner either.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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8 months ago
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Thank you for your prompt reply, doctor. Yes, I live in the U.S. and my CSW is a female. I became worried and confused when my wife said her sore started without any pain and the sore still remains painless. I don't recall if she was prone to cold sores on the lips in the past. All my cold sores on my lips have started with a stinging or burning sensation. My other confusion was what a syphilis chancre looks like. Some photos on the internet showed Syphilis sores that were not small, hard, and round. Your assurance on my and my wife's status helps. I will also plan to retest in a couple of weeks for peace of mind.
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8 months ago
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My wife informed me she has never had cold sores on her lips. Right now, she also has some painful cracks in the corner of her mouth on both sides. But, she has herpes outbreaks on her buttocks at times.
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H. Hunter Handsfield, MD
8 months ago
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These comments in no way change my assessment and advice. There is great variability in symptoms with oral herpes outbreaks. That yours start painfully and your wife's oral sore did not means nothing. The appearance and evolution of the lesion -- how it has behaved in the days since it started -- are far more important. That you have HSV1 increases the possibility that your wife does too, even if this is her first recognized outbreak; you could have infected her any time since your relationship began. I'm not saying she has herpes, but it is possible and infinitely more likely than syphilis.
As you have found, there is great variability in the appearance of syphilitic chancres. They are classically described as painless, firm, usually round, etc. But that description describes only about half of all chancres. Nevertheless, your description of your wife's lesion is very atypical and the timing is all wrong as described above. I remain confident neither your nor your wife (and probably your CSW partner) do not have syphilis.
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8 months ago
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Thank you so much for your valuable advice and service to us all. I have sent in a donation to support your organization's work.
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H. Hunter Handsfield, MD
8 months ago
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I'm glad to have helped. ASHA thanks you for your contribution to their important work. Best wishes and stay safe.---