I received a handjob (only that, no fluid exchange) from a Chinese CSW 28 days ago. I didn’t notice any lesions on her hands, arms, or torso. Thanks to a user on ASHA Inspire who replied to my concern (link) and redirected me here, I’ve read many of your responses and understand hand-genital contact is extremely low risk for syphilis.

A few hours after the encounter, she kindly sent me a photo of her palm—no visible signs of rash or lesions. I know you can’t evaluate photos, but I don’t see anything suspicious.

I’ve had no symptoms on my glans or shaft at all. I plan to test on August 1st (CLIA or EIA in an STI center, possibly with titer and immunoblotting). Questions:

1. If she had an undetected secondary rash, how risky was the contact?

2. Is 28 days without symptoms clinically reassuring?

3. Would my test on day 31 be conclusive?

I’m struggling to find peace and truly hope a reply from one of the top experts may help bring me mental relief.

Dr. Hook,
First of all, thank you very much for your reply. I truly appreciate your time and expertise.

Due to the character limit in the original question, I wasn’t able to give some useful background. The CSW has been working in Italy for several years, where STI testing is completely free in public hospital-based clinics. So she has every opportunity to monitor her sexual health. Also, she is still actively working. These facts significantly reduce the chance that she had an active STI at the time—especially something as visible as a secondary syphilis rash, which I assume would rarely go unnoticed.

Before posting here, I had already contacted the national helpline of the Istituto Superiore di Sanità (Italy's top public health authority), and they told me: “If she had anything infectious on her hands, you definitely would have noticed.” I also spoke with a physician from an Italian STI NGO who said: “The risk is extremely low, but to be extra cautious, avoid sex with your partner and take a treponemal test after 4 weeks.”

Because I received slightly mixed messages, I decided to ask here—where the world’s top STI experts provide clear, experience-based guidance. Your reply was very reassuring and helpful, and I thank you again.

That said, I hope it’s okay if I ask a few brief follow-up questions:

I scheduled a test on August 1st (31 days post-contact) before leaving for vacation with my wife and children. Given the near-zero risk, absence of symptoms, and the fairly high sensitivity of CLIA/EIA tests at 4–5 weeks, would that test reasonably provide closure?

Dr. Handsfield once said: “Some asymptomatic cases of newly acquired syphilis have no chancre at all.” Is it possible to have primary syphilis without any signs, or was he referring to mild or unnoticed chancres? Could completely silent primary syphilis happen only in immunosuppressed individuals? I’ve checked myself daily due to anxiety.

Lastly: due to mild phimosis, my glans stays covered. If infected, would a chancre appear on the shaft/glans, not the inner foreskin?

Your reply brought me real peace of mind.