[Question #13017] Syphilis risk assessment.
3 months ago
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Hi Doctor,
I would love your assessment on the chance I may have syphilis I am really freaking out now. I have a stable female partner, and sometimes I have engaged in MSM with a friend with regular testing. Timeline:
End of Feb: last sex with wife (always unprotected).
Up to March 22, visited another city, had protected sex with friends both top and bottom a couple times. Unprotected oral. He tested all neg before meeting, and yet again March 22, as I did, cause we went together, last time we met. I am sure no other contacts any of us.
March 12: I visited a MSM encounters place, only saw and masturbated myself, no contact with anyone. Took doxy prep 30min later.
March 23 I developed a burning and painful sore on my shaft/scrotum area, never looked like chancre, it was bright and super painful, 1-2 days later it scared and by 6 days it was gone. I treated with HC and even had to wear circumcision boxer to alleviate. This was in my mind a friction masturbation burn, as this area always ends up painful and burning.
Nothing new up to today.
Friend told me Apr 5 he assisted a sex house and only saw, but seated nude on dirty furniture.
By April 20 he noticed something he claimed ad auto diagnosed as granulome inguinal and took 3 azy 1g doses weekly.
I am freaking out I had gotten syphilis from bath house and passed to him, cause chancre looks a lot like granulome.
He did a rapid Syphilis HIV dual test both neg May 9, 5 weeks after his exposure, and 7 after I last met him. He was already week 1 of azi.
Is there any chance I may have gotten syphilis at bath house after doct and passed to him and he be negative 7 weeks with rapid test?
3 months ago
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He is taking a vdrl tomorrow, and I of course plan on taking one if positive.
Freaking out cause I had unprotected sex with wife March 25, when friction burn was developing.
3 months ago
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Forgot to mention, friends lesion was near anus, and got better starting azi.
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H. Hunter Handsfield, MD
3 months ago
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Welcome back to the forum. I'm happy to address these issues.
Clearly you are at significant STI risk from the sexual events and lifestyle you have described. (This seems a major change since your previous question 3 months ago -- more about which below.) The sexual exposures you describe could have risked syphilis, although the chance probably is low. The transient genital sore you describe was not typical for syphilis -- it indeed sounds like a friction burn. Herpes also is a possibility, although also not typical for that STI.
Interesting that one of your partners has been diagnosed with granuloma inguinale. That is an exceedingly rare STI, especially in the US or other industrialized countries. Where do you live? In my 50 years in the STI business I have never seen a case. If you're not in a geographic area known to have occasional cases, I have to be skeptical about that diagnosis. And syphilis could mimic GI, so perhaps that is a consideration. On the other hand, his negative blood tests prove he doesn't have syphilis.
I would advise you have a syphilis blood test and that any potentially exposed sites (urethra, rectum, throat depending on specific sexual practices) be tested for gonorrhea and chlamydia; and that you have an HIV blood test in addition to syphilis testing.
In your last question, you described a single sexual exposure with a male partner as if it were a one-time event. Clearly things have changed. Assuming you are continuing sexual activity with your wife, she also needs testing for gonorrhea, chlamydia, HIV and syphilis. And it would be a kindness to inform her about your sexual activities with other men.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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3 months ago
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Hi doctor,
Sorry I was not clear as I was freaking out.
I have had a few encounters with my friend over the last couple years. But we test at least 3 times: He does a few weeks after any encounter he may have and before I visit him and takes prep and doxy pep. We then go together at 6 weeks from his exposure, and yet again a few weeks after we last meet.
This time I have already tested for Chlamydia and gonorrhea.
He tested negative for them as well. As well as hiv and syphilis 7 weeks after our last encounter.
He was NOT diagnosed GI, he self did and took azy. We are from Mexico. I am also skeptical and freaked out when he let me know before we engaged this time, so I suggested repeating the vdrl.
His negative rapud syphilis was 5 weeks after he came to that sex party where he only looked (we are both paranoid). He repeated today, he will have results later.
His sore looked nothing like mine, his was red and definitely an ulcer, mine started a swollen burning skin that got a super thin scab a few days later and even walking or rubbing pants was painful.
We have chatted on this, and I cannot continue doing the this to myself, so we have agreed to stop engaging at all, hope this is a wake up call.
It seems improbable I am the source of whatever he has, as his test 7 weeks should have been positive if so. But it also seems improbable he got an ulcer next to his anus without any direct contact. Ye swears he only looked and I believe.
Whatever the reason for his sore, would you say his test 7 weeks should have been positive if it was syphilis from me, eve more of he already had the sore a couple of weeks by then?
3 months ago
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I should also mention, I did not engage with "friends" it was one. Only him, and always under the excessive testing patter of each before, during and after each visit.
3 months ago
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His vdrl just came back as negative.
9 weeks after he last saw me and 6.5 after he went to sex party.
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H. Hunter Handsfield, MD
3 months ago
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Your and your male partners' test results are conclusive that neither of you has syphilis. Self diagnosis of granuloma inguinale is nonsense; you can safely assume he doesn't have it and never did. I agree you are not the source of either this problem or any other STI that he might have. Your friend should stop trying to diagnose himself; if whatever he has is continuing, he should see a doctor for proper medical evaluation in person.---
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