[Question #13791] Need closure (syphilis test)

16 days ago

Hello doctors, I had a low risk exposure (oral sex both ways during approximately 30 minutes, and no anal sex) with a male partner that informed me after two weeks that he had been exposed to a syphilis positive partner. I can’t reach him anymore (he doesn’t answer anymore) and can’t know if his tests ended up actually positive. Fast forward to now, I had negative TPPA tests at 21, 28, 35, and 41 days post exposure. (We are now at 45 days+) I had no symptoms whatsoever and feel perfectly fine (if you except the horrible stress). Can I move on with my life ? I tested less than 24 hours before the « 42 days » window, and I read a lot of things about the 3 months window also on official sites. Can you help me ? I reviewed countless of your answers but I feel like only a personalized answer will put an end to this.

16 days ago

Have to add that I'm also a male and that the oral sex was unprotected.

Thank you for your amazing work on here

H. Hunter Handsfield, MD

16 days ago

Welcome. Thanks for your confidence in our services.

First, the sexual event probably was low risk: oral sex certainly can transmit syphilis but does so a lot less commonly than anal or vaginal sex. Second, that your partner has not contacted you more recently actually is reassuring: most confirmed infected partners do inform their partners at risk, and in many settings public health departments also take responsibility for informing partners. In other words, having heard nothing except that your past partner was "exposed" is likely to mean he wasn't actually infected. Third, if you had acquired syphilis, probably you would have had obvious symptoms, i.e. an open sore (chancre) at the site of infection, i.e. your penis or your mouth.

Finally, to your specific question: Interesting that you had TPPA testing, which is not the norm in most countries, including the US. However, it's a very sensitive test that probably is always positive within 6 weeks of acquiring syphilis. So on the basis of the test results, you can be very confident you were not infected. It is correct that some sources say 3 months, but that figure is for the more commonly used RPR, VDRL and similar tests; I am unaware of firm data on TPPA, however.

All things considered, I would say the combination of these four factors (low risk to start, no new info from your partner, no symptoms, and negative test results) together make it 100% certain you do not have syphilis. Of course you are free to have a final blood test at 3 months if another negative result would give you more confidence. But if somehow I were in your situation, I would not do it.

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

HHH, MD

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15 days ago

Thank you doctor, it's very reassuring.

Just to be sure, assuming my partner was syphilis positive (in the worst case), your answer would be the same ?

Also I did auto tests which explains the TPPA TEST. The instructions for the text recommended to test after five weeks..

Thank you so much for everything you are doing.

15 days ago

Ps : I am in France and the test is European Union certified. (The brand is Patris Health)

H. Hunter Handsfield, MD

15 days ago

Yes, I'm aware TPPA has become a standard syphilis screening test in many countries, including much of Western Europe. And yes, even if your partner had active, transmissible syphilis, your negative test results plus lack of symptoms are solid proof you were not infected. But if you remain in doubt, discuss it with the doctor or clinic where you have been tested; and consider whether to have another test at 3 months after the exposure, for additional reassurance.---

15 days ago

Thanks for everything take care doctor Handsfield.

H. Hunter Handsfield, MD

15 days ago

Thanks for the thanks. I'm glad to have helped.---