[Question #1698] Is this Syphilis?

43 months ago
Very scared here. Married straight 25 years and received oral from a male 14 weeks ago.  I did a 10 week full test (blood/urine) for HIV, CT, GN, HSV1/2, TRICH and Syphilis. All negative. Symptoms are mild pain after urinatation and what seems like wet feeling and every time I check there's no discharge. My prostate is enlarged and maybe it's prostatitis? Flow is weak at times. I did take 1g of Zith and 100 mg Doxy for 7 days after the 10 week test. Tested AGAIN @ 12 weeks for GN/CT via urine and still negative! I see wart patches at head of penis and that seems to be damp? But I had warts  
removed from inside my my penis 30 years ago and I remember those always being there, I think? I always assumed those warts were HPV? My eyes are now red and irritated and now I'm freaking out about Syph!! Can I trust the 10 week Neg RPR?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to our Forum.  I'll be glad to comment.  You can be confident at this time that you did not get any STI, including HIV from the exposure 14 weeks ago.  Your test results for all STIs- gonorrhea, chlamydia, HIV and syphilis now provide reliable proof that you were not infected and there is no need for further testing.  I will provide a little more information to you below providing some background and rationale for my statement but the bottom line is that you can be confident you were not infected through the exposure you mention and you can now move forward without concern. 

By way of background, getting STIs of any sort from receipt of oral sex is rather uncommon.  There has never been a case of HIV shown to be acquired from receipt of oral sex, and both syphilis and chlamydia are VERY rarely acquired in this way.  From time to time persons may acquire gonorrhea or non-gonococcal urethritis but this is also relatively uncommon- most people do not have STIs to transmit and in those who do, only a minority of exposures to infected persons lead to infection.  Further, in your case, if you had gonorrhea, chlamydia, NGU or syphilis from this exposure, the azithromycin and doxycycline you took would have cured them. 

Also, the symptoms you describe (conjunctivitis, possible incomplete emptying of your bladder and pain AFTER urination  are not STI symptoms.  I suspect the conjunctivitis is an unrelated problem and the urinary symptoms may reflect prostate problems but again, certainly NOT STI. 

I hope this information is helpful to you.  Take care.  EWH

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43 months ago
I thank you very much as my anxiety levels have been very high for over 2 months and generally feel not myself and light headed. I do have occasional pain if left testicle but no rashes or lesions other that the warts. RPR are basically conclusive at 10 weeks is what I guess your telling me. Could this be prostatitis or CPPS in your opinion or is it me making myself ill at this point?
43 months ago
Good morning Dr. Hook. I thought I'd just get my last questions in now and hopefully you will comment on all at once. So right to it. Current and on/off symptoms are; irritated penis head, gurgling stomach/cramps, left testicle pain, knee pain, light headedness, sore and tingly under both arm pits (lymph nodes?) neck glands seem large or swollen, twitchy and red eyes with light discharge. No rashes other than what seems like damp wart underneath penis head and recent anal sweating. Perineal seems larger but not sore. Some night sweats. No headaches. So,
would you still stick with your original diagnosis? Thanks again as I really need some closure here. I've read a lot of false pos RPR but very few if any false neg unless it was to soon and 10 weeks should be conclusive. 
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Correct, you should believe your RPR results.  You do not have syphilis and there is no reason to be worried about this going forward.  Your exposure was low risk for syphilis, you have not developed signs or symptoms of syphilis (no matter what the internet tells you), and you have a highly reliable lab test with almost no false negaitv4e tests at this time which confirms that you did not acquire this rare disease. 

As I said earlier, the symptoms you are experiencing are not suggestive with an STI of any sort.  Prostate-related, non-STI problems are a possibility as is CPPS.  Also, as you acknowledge, your anxiety (and I suspect guilt) over your exposure appears to have contributed to a heightened sense of awareness of sensations and possible symptoms which contribute to your concerns.  Again, I can assure you, this is not an STI.  Perhaps my statement to this effect will help you to move forward.  If not, I suggest you discuss this with a urologist and consider discussing your concerns with a trusted, confidential counselor.  EWH

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43 months ago
I thank you again very much. You are correct about the stress and guilt for sure! Today I feel very tired and weak and I have some potential colon issues as well. Seeing gastric tomorrow to go over fecal occult results. Maybe this where the problem is or the prostate. 
43 months ago
One last question Dr Hook before I move on. Could I have contracted a mycoplasma like MG or UU? I did have unprotected test with my wife after this exposure but only a few times and but no sex for 2 months now. She doesn't seem to be complaining of any symptoms but also had a planned hysterectomy 2 weeks ago. Is MG or UU commonly passed from receiving oral?  Had all tests repeated since are last talk above and all results were negative. 
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

There is no good evidence that UU is an STD, as opposed to an organism the colonizes the genital tract.  As for M. genitalium, there is no evidence that it is an important pathogen transmitted through oral sex.  I would not worry.

This is my third reply to your questions, thus this will end this exchange and the thread will be closed later today. EWH

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