Hello, I’m sorry to bother you again regarding question #13278, but I need a follow-up. 

Day 0: handjob by a CSW.

Day 55: TPHA + VDRL negative. 

Day 60: 1 mm non-painful foreskin cut (round when skin retracted), healed in 3 days, not indurated.

Days 63, 70, 77: three home rapid tests (Prima Lab), all negative. 

Day 84: ECLIA 0.11 (<1 = neg) and VDRL negative. 

Day 90: similar foreskin cut, healed in 3 days. 

Day 92: CLIA <0.1 (<0.9 = neg). 

Day 100: one pink forearm spot and two shoulder spots. 

Day 105: TPHA + VDRL negative. 

Day 115 (today): STD doctor said no further test was needed, classifying shoulder spots as seborrheic keratoses and the forearm one as likely dermatitis. 

I’m still anxious that symptoms could relate to syphilis and tests might have been false negatives. 

1-Can syphilis be completely ruled out, and what diagnostic certainty (%) can be assumed? 

2-Does NTT/TT positivity depend on the appearance of a chancre, or is there a timeframe after which antibodies are always detectable? 

3-If those spots were secondary syphilis, would tests done 4–5 days later be expected to be positive?

I'm troubled that you feel the need to return for further reassurance despite multiple negative tests, prior reassurance from me and most recently, reassurance from your won doctor that you did not acquire any STI from the virtually no risk event that you described.  This suggests that you must feel a great deal of guilt and unwarranted anxiety from the encounter you describe.

Your results from day 60 beyond were unnecessary and redundant.  It has been said that one definition of insanity is to do the same thing again and again and expect a different result.  YOU DID NOT ACQUIRE SYPHILIS FROM THE ENCOUNTER YOU DESCRIBED!!!!

You have tested with multiple different tests which provide the same answer again and again, showing that you do not have syphilis.  Virtually all persons with secondary syphilis have positive tests.  Thus, in response to your specific questions:

1.  Syphilis has been ruled out with 100% certainty.

2. Persons with secondary syphilis always have positive tests.  You need to believe them

3.  Yes

I suggest that rather than pursuing further tests, you seek confidential, professional counseling to determine and address why you are having so much trouble moving forward.  I say this out of concern for you, nothing more.  EWH

Dear Dr. Hook,

Thank you very much for your time and clear response. I truly appreciate your patience.

I’m naturally anxious, and guilt (having a wife and daughter) made it worse. I repeated tests because each negative result was followed by new symptoms (small foreskin cuts at days 60 and 90, pink spots at day 100) which made me doubt again.

If I may, I would like to ask a few general questions, not related to my specific case but to help others who may read the forum:

1- Can a syphilitic chancre heal completely in less than 1–2 weeks and be small (<5 mm)?

2- Is NTT positivity linked to the chancre’s appearance?

3- Since TT positivity depends on immune response, is there a maximum timeframe after which TTs are always positive? (Tests like CLIA/ECLIA/EIA may be more sensitive than TPHA early on — not asking for details, just a general idea.)

4- Are secondary rashes typically numerous, bilateral, and lasting at least a month?

I will most likely follow your advice and seek professional help to take care of my mental health.

Best regards.

Syphilitic rashes may be symmetric and are highly variable in appearance.  In Dr. Handsfield's book on genital dermatology fewer than 15 of the more than 300 pages show dermatologic lesions due to STI- the remained are non-STI in nature.

My assessment and recommendations remain the same- you doo not have syphilis and you should seek counseling to address your unwarranted ability to move forward.  EWH

Dear Dr. Hook,

Thank you very much for your patience and for your clear explanations. I sincerely apologize if I’ve seemed repetitive or insistent — as you surely know, anxiety, especially when fueled by guilt, can easily take over in these situations. I’m really trying to convince myself that I did not contract syphilis, and that the test results, the opinion of the STD center doctor, and your own expert assessment are far more reliable than my irrational fears.

If I’m not able to overcome this on my own, I will definitely follow your advice and seek professional help.

Thank you again for your time, kindness, and understanding.

Best regards, with promise I’ll not come back with anxiety-driven questions.