[Question #1800] Syphilis retest required?

42 months ago

Hi Doctors

I am driving myself crazy at the moment and I'm pretty sure I am being totally irrational.
On the 29th of December I had unprotected oral sex (both ways) with a CSW in Manchester England, there was also French kissing and the woman in question was Swedish/Finnish, don't know if that makes a difference?
At 32 days I did a urine test for both Chlamydia and Gonorrhea. Both came back negative. I also completed an instant syphilis test with the Doctor in the office. He took some blood and result was available 10-15 minutes later. It was negative. He said there was no need to test further and forget it.

I couldn't let it go and wasn't happy with the selection of the rapid test as I hadn't read about them being used as standard outside of 3rd world countries. So at 46 days (6.5 weeks) I decided to test again. This time I did a lab based IgG/IgM by EIA which also came back negative.
Can I treat this test result as conclusive and forget about syphilis infection for good? How accurate is that test at 46 days?
The NHS in the UK and other agencies says you cant have a definitive test for syphilis until 12 weeks, Whereas STD experts like yourselves abd Dr Sean Cummings say 6 weeks is conclusive. This conflicting information is putting me on edge and the thought of having this hanging over me for another 4 weeks is driving me mad. Would you recommend retesting in my position?
I'm terrified of passing something on to my wife to the extent that I have barely kissed her on the lips this past 2 months.

Thanks in advance.             

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Welcome to the Forum.  Please understand that agencies such as your NHS or my CDC must provide GENERAL information which is not individualized.  In your case, after two negative syphilis tests and with no lesions following what was a very low risk exposure (syphilis is now uncommon among heterosexuals, even commercial sex workers and very, very rarely spread through oral sex), no signs of infection, and two negative tests, you should consider that you have now effectively proven that you did not acquire syphilis (or gonorrhea or chlamydia, based on your test results) from the exposure you describe.  There is no medical reason for further testing.  Time to feel completely safe in resuming all prior, unprotected contact with your wife.

Remember, Einstein said (paraphrasing) that one definition of insanity is to do the same thing again and again and expect different results.  Take care.  EWH

---
42 months ago

Dr Hook

Thanks for your speedy reply and reassurance.

I imagine guilt and anxiety are running away with me, but that is my issue not yours, and I will seek appropriate counselling / treatment.

If I had a lesion would it have been obvious? I.E. on my lips, tongue following the French kissing / cunnilingus. Head of penis following fellatio.

I just want to be 100% certain I've covered all my bases and don't expose my wife to anything. I would never forgive myself and she certainly doesn't deserve to contract anything because of my foolishness.

I'm guessing that if I were one of your patients you would dismiss me with no need for further testing?

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Yes, the lesions of syphilis are typically obvious. They can be missed by persons who are not looking for them but my sense is that you have been looking for any possible signs and therefore would have noticed.  lesions would only occur at a site of direct contact. You would no miss them.  there is NO medical reason for you to test further.  EWH
---
42 months ago

Once again Dr Hook, thanks for your response.

This is essentially all I've thought about for nearly 9 weeks so I think I've convinced myself that I must have it, or that I deserve to have it. I'll do my best to put it behind me now.

If you would indulge me two more (stupid) questions. Had I developed a chancre and missed it I'm assuming my blood tests would have been positive?

Also given that I'm now approaching 9 weeks I assume that it's too late for a chancre to materialise?

Thanks again for your help and the service you provide, it has been a great help.

Apologies for the anxiety driven (and no doubt annoying) questions.

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Clearly, your guilt/anxiety is overwhelming you.  As you know, this will be my final reply as part of this thread.  Subsequent repetitive, anxiety-driven questions run the risk of being deleted.

It is too late for a chancre to appear.   Syphilitic chancres typically appear by about 21 days after exposure.  Nine weeks is beyond the time they might appear.

Take care.  EWH
---
42 months ago
Hi Dr Hook

I have seen on some replies that you said theoretically it could take 3 months for syphilis to show up in a blood test. 

With that in mind how can you be so certain that I am in the clear and not a risk to my wife?
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Final answer (n.b.  Forum guidelines call for three replies per question, this is your 4th.  The thread will be closed later today.)

The estimate of three weeks is based on conservative estimates of the time needed for evaluation contacts of persons with PROVEN syphilis who may not know of their exposure.  In your case,  you know of your potential (albeit statistically VERY, VERY low risk exposure), have been looking for signs of infection and have been tested.  All of this was considered in my reply to you.  You asked for an individualized, expert assessment.  You got it.  No change in my assessment.  you are worrying needlessly at this time.   EWH

---
42 months ago
Dr Hook

I appreciate you bending the rules for me and providing a final response.

I value your advice and will take it onboard in the hopes of moving forwards.

Many thanks for your help, patience and the service you provide.

All the best.