[Question #12838] Syphilis Concern

4 months ago

Hi-

Concerned of a risk of STD, specifically syphilis scare after oral exposure. Man gave me unprotected oral sex for around 1-2 minutes, I did not finish in his mouth but rather by my self next to him and onto the ground.

I was nervous for about the 2 weeks even though he said he was 100% clean and tested recently. I monitored for 2 weeks, and I did not have any puss or painful urination, ask based on what I read here gonorrhea is extremely unlikely. Also I haven’t noticed any visible lesions on my penis or area there at all, nor do I have itching there

Fast forward we are 3 weeks removed from the encounter and I have matching rashes under my armpit. I went over to a neighbor who is a dermatologist and she said it looks like atopic dermatitis and I should use triamcinolome cream twice daily. She also said since I am a runner, it could be caused from that. I also recently have been feeling like I have a “hot chest”, itchiness there but no visible issues.

What are the chances that is it a syphilis rash? Can it look like dermatitis rash? The pictures from Google look nothing like what I have? No red dots, rather just irritation line

How likely is syphilis spread from oral? The encounter was literally a minute, and my previous encounter was 5 months ago, also only oral for 2 minutes max.

Can the first noticeable symptoms be an armpit rash?

H. Hunter Handsfield, MD

4 months ago

Welcome back to the forum. Before going to your questions, I'll make the general observation -- based mostly on your last question a few months ago -- that you are over concerned about STI risks, especially in view of your apparently usual exposures (oral sex, both giving and receiving).

In this case, you describe a partner who probably has no transmissible STI; people rarely lie about this when asked directly. Even if he had syphilis, transmission by oral sex can occur but is rare; and nearly zero for the very brief exposure you had.

If you acquired syphilis, your first symptom would be a chancre (open sore) of your penis, your only exposed site; usually chancres appear within 2 weeks of exposure. The skin rash of secondary syphilis usually starts 2-6 months after acquiring the infection and never before 6 weeks. And an itchy rash of the armpits doesn't even hint at syphilis; I'm sure your doctor's diagnosis is correct. None of your other symptoms fit with syphilis either.

This was sufficiently low risk that you do not need testing for syphilis or any STI. In absence of typical symptoms, we almost never advise testing after a single exposure, even when much higher risk than yours. A much smarter plan is to get tested from time to time, after several possible exposures. Depending on how frequently you have events like this one, maybe consider urine testing for gonorrhea/chlamydia and throat swab for gonorrhea every year or two;' and syphilis and HIV blood tests at the same time.

That said, of course you are free to be tested anyway: reassurance is a legitimate reason for testing even when it isn't advised for medical or risk reasons. If you decide to be tested for syphilis, have a blood test 6 weeks after the event. I am very confident you do not have syphilis and a blood test would be negative,

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

HHH, MD

---
---

4 months ago

Thank you for your super quick reply.

Your assessment of my overconcern is probably correct due to guilt and other issues. I will add some clarification below with some follow ups.

1. First encounter, 4.5 months ago was a bit of mutual oral but last no longer than 5 minutes and finished on my own and not in him. 2nd encounter was 3 weeks ago and was 1 min of oral for me and didn’t finish on or in him. Regarding either encounter, you don’t think that the armpit rash or “hot/irritated chest”, which is upon review definitely irritated and red in my upper torso, could be related to the first encounter?

The first encounter was around 4 months ago. I really don’t see anything on my penis or in that area but am nervous I just have a syphilis chest rash and it will spread. Is it possible for the disease not to be localized and just have the syphilis rash in my armpit and chest?

Also, does the timeline and exposure clarification further change your assessment of risk?

I have some pimples on my butt cheeks, how do I know if they are chancres? Is there anything about the rash progressing from armpit to chest, that would change your original assessment of extremely low risk and not worth testing?

I am planning on getting tested tomorrow AM, even though it might be a bit early on the 2nd encounter, but should be enough time to rule out first encounter.

H. Hunter Handsfield, MD

4 months ago

Nothing in this additional information changes my evaluation and advice, or my judgment of the timeline. It appears the previous encounter on your mind is the same one addressed in your previous discussion with Dr. Hook. Re-read his comments and advice if you remain concerned about that event. I agree 100% with Dr. Hook. I see no reason to repeat his advice. There's also no reason I should repeat my advice above about your underarm rash. Re-read that comment: I haven't changed my mind in the last couple of hours!

Yes, it is possible (in fact very common) for syphillis to be silent with no symptoms or signs. That doesn't mean it is likely you have syphilis. I assumed you already have had at least one negative syphilis blood test that proves you didn't catch it from the previous encounter. If not, then yes: your negative test tomorrow will prove you were not infected then -- and will further reduce the chance this time as well, although 6 weeks is needed for a conclusive test result.

Pimples are nothing like chancres. And your butt cheeks were not the exposed sites. (Just getting some of your partner's body fluids on. your skin does not risk syphilis.)

You have one follow-up comment coming. Please do not ask me to confirm what you've already been told; I will not respond to such questions.

You're way off in the deep end over this. Just stop worrying and have a final blood test at 6 weeks. It will be negative, as will tomorrow's test result.

---
---
---
---