Dear Doctor,

I apologize in advance if my English is unclear, as I am from another country. I’ve never had sexual contact, but I recently got my earlobe pierced at a piercing shop. The black nitrile gloves used were clearly reused, and I didn’t see the disposable needle being opened, which makes me concerned it could have been reused. (Cannula Needle)

Around 50 days after the piercing, my lymph nodes became swollen. Could infection occur if:

• Blood on the gloves contaminated the needle, or

• A reused needle with blood pierced my ear?

I understand that HIV and syphilis do not survive well outside the body, but if blood containing these pathogens stayed on a surface for 5–10 minutes, what if my ear was pierced during that time? Can the usual window periods still apply in a non-sexual situation like this piercing? Could antibodies develop later than usual?

I also think I should get a Treponemal test. I know the chance of infection is extremely low (but not zero), but if infection did occur, when would it likely show up in testing? When would testing give a definitive result for 100% certainty? I’m anxious.

Tests so far:

• Jan 19: Piercing

• Feb 27 (+39d) & Mar 9 (+49d): RPR negative, HIV AgAb negative

Thank you, doctor.

You should not be worried at all. In the entire 4 decades of the world wide HIV/AIDS epidemic, nobody has been infected in the manner you are concerned about. Even if there had been any risk, you r negative test results prove you were not infected with syphilis or HIV. Therefore all the other things you mention are irrelevant:  whether or not there was blood on the gloves, the needle was contaminated, HIV/syphilis survival outside the body, re-use of a needle -- all make no difference and should not be on your mind.

All is well. You have neither syphilis nor HIV. Do not have any more tests and do your best to stop worrying.

Let me know if anything isn't clear.

HHH, MD

No sexual intercourse; doctor suspected yeast infection (or bacterial vaginosis) and prescribed 16-day medication course”

Methylprednisolone/ Bepotastine/ Levocetirizine (5mg)/Mosapride - Prokinetic agent/ Fluconazole (150mg)

=> Would these medications affect the RPR test?"

I’ve read that there have been rare cases in India where HIV or syphilis was transmitted through piercing procedures. 

Piercing shops in the U.S. require a license, but in South Korea they don’t. I got my piercing at an underground mall shop near the subway, which is mostly visited by Japanese customers among foreigners. I’m worried because I’ve heard that syphilis is on the rise in Japan.

According to the information I read, the available data aren't all that precise for syphilis, although they are very conclusive for conclusive HIV results with the AgAb (4th generation) blood tests.'=> So right now, I’m not really worried about HIV. My main concern right now is syphilis.

So, if syphilis is transmitted through non-sexual routes (like piercings or tattoos), could it take longer for antibodies to form and for it to be detected, especially if only a very small amount entered? Is the reliability of the test results the same as when it's transmitted through sexual contact?

I really want advice on what type of test can 100% confirm that I haven't contracted syphilis, and when I should take that test."

(Would it be more accurate to get a treponemal test, like TP-PA or FTA-ABS, in order to obtain a more reliable result sooner?)

I don't care what you have read. No such cases have reliably been documented or reported in the medical literature. 

"Piercing shops..." etc:  This makes no difference."

According to the information I read...." Once again you have found an unreliable source. I suggest you stop searching about these things online, or at least restrict yourself to professional or professionally moderated sources. Especially avoid source by and for people with the health problem you are searching about -- like Reddit for example, where anyone can write whatever they want and there are no scientific standards.

How syphilis is transmitted or acquired cannot have any effect on the reliability or timing of tests for it.

The RPR you had is 100% proof you were not infected. But if you like, you could request a T. pallidum specific IgG/IgM test, like an EIA. Or TPPA. If you do so, it also will be negative.

You're really off the deep end on this. (If not familiar with this idiomatic English term, look it up. If means you are far, far over concerned about problems that have no possible reality in your life. This is very abnormal thinking and suggests a possibility need for psychological care. I suggest it from compassion, not criticism.

=> "I may have miscommunicated the meaning of that sentence because I was using a translator. However, I saw that sentence on Ask the Experts, and it was taken from something said by either H. Hunter Handsfield, MD, or Edward W. Hook, MD."

(This is not from "Ask the Experts") 

I've heard that syphilis has an incubation period of 10 to 90 days, and that asymptomatic cases can be detected later. I also saw that, very conservatively, follow-up testing is done for up to six months.

 => Is this wrong?

Even if I exclude the very low risk of infection, is the 12-week test really definitive? I'm not asking because I want to cause unnecessary anxiety. I just want a clear answer on when and what kind of test to do to be truly definitive.

*"I read the following on Ask the Experts (please excuse any awkwardness, as it was translated from my native language to English):

• Dr. Handsfield: Reports of a positive RPR or VDRL reaction being delayed up to 3 months have only been occasional reports or personal experiences.

• Dr. Hook: The recommendation to wait 12 weeks for a positive confirmatory test reflects a combination of conservatism and outdated information.

1. With that in mind, does taking the RPR test at 12 weeks really provide 100% certainty, regardless of the route of infection?"

2. And if I want to be even more certain, you suggested a TP-PA or FTA-ABS test—when would be the best time to take those to get a definitive result?

I greatly appreciate your time and guidance. Doctor

Regarding RPR or TPPA/FTA tests, if only a very small number of syphilis bacteria enter the body, could their slow replication delay the appearance of antibodies?

My ears and neck lymph nodes have been swollen since day 51, but my RPR test on day 49 was negative. Does this mean that the swollen lymph nodes are very unlikely to be caused by syphilis?

I’m sorry for bringing up these questions a bit late, but your advice has been really helpful. If the swollen lymph nodes aren’t due to syphilis, I’ll make sure to visit a clinic to investigate other possible causes.

The tests prove that any and all symptoms you have are not due to syphiis.

Most lymph nodes around the ears and neck are due to common cold viruses, are not serious, and clear up on their own. And many bumps in this area felt by non-medical persons are not lymph nodes or anything serious. If they clear up, you don't need to see a doctor. You should stop examining yourself.