[Question #1965] Syphilis in other person increase risk of insertive oral ?

48 months ago
Dear Doctor 

I had insertive oral sex for about 30 seconds after which i saw a small tear in my foreskin. It was in switzerland but the girl was from Slovakia . There was also deep kissing.

On day 10 i took a VDRL test which came negative . I did not have syphilis at the time of exposure 

My question is - if the girl had syphilus ( and i dont )  , does it increase my risk of getting HIV (due to coinfection) because of either the kissing or during insertive oral sex . Does it apply to insertive oral sex or receptive oral sex ? 

Im worried because i have today a small ulcer on my finger (day 17 after exposure ) . 

very worried . 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Welcome to the Forum.  I'll be pleased to comment.  I would rephrase your question however to include whether or not it is likely that your partner had syphilis, and if so, was it likely that you were exposed (again, no).  The answer to the first question is no because your sex partner was a woman and not only is syphilis a rare STI (even among commercial sex workers) but also because at this time and for that past few years, over two thirds of syphilis occurring in North America and in Western Europe has occurred among men who have sex with other men, not among heterosexual men and women. Therefore it is quite unlikely that your partner had syphilis, making it even more unlikely that you acquired syphilis in the exposure you mention.

Secondly, it sounds as though although she performed oral sex on you, you did not have penetrative genital sex with her.  Receipt of oral sex, plus kissing are the only exposures you mention.  Thus, unless your partner had a syphilis sore on or in her mouth (very rare even among people with syphilis), it is unlikely you were exposed.  Syphilis is only transmitted through DIRECT contact with a syphilis lesion. 

I she had syphilis and she had HIV, she would possibly be slightly more likely to transmit either infection than if she only had one of them (syphilis or HIV) but still the risk of your getting syphilis (or HIV) through receipt of oral sex or through kissing in very, very low and should not worry you.  It would not worry me. 

Finally, the lesion on your finger might only be syphilis if your finger had contacted an active syphilis lesion during your encounter.  Like oral syphilis, syphilis lesions on the finger are very, very uncommon.  If the lesion on your finger was due to syphilis, I would expect your syphilis blood test to be positive at this time as well. 

I hope this information is helpful to you.  EWH
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48 months ago
Dear doctor

Thank you for your answer.

To be honest , this happened to me at a strip club in Switzerland on a work trip. My colleagues bought me a lapdance. Unfortunately it involved about 60 seconds of deep kissing and 20 seconds of unprotected insertive oral ( blowjob) from a stripper from slovakia.
Out of fear and guilt , i  stopped it within 20 seconds . I wasnt expecting it but still should have stopped it early. There was no intercourse at all. Next day i noticed a tear in my foreskin with a small drop of blood  when i squeezed it hard. I got very scared and rushed to the emergency in switzerland
The doctor said i have "zero" risk from this incident and he didnt prescribe any pep. However i didnt believe him and after much requesting he gave me the pep prescription.
So 27 hours later i was on pep despite him saying no. 
Now that im back in india on day 17 i have major side effects of nausea and headache. Im worried about every symptom because of syphilis and hiv.I have no doctor to talk to so i just keep taking tests.

I came clean to my wife and family and they have stood by me like a rock. I feel very sad, anxious and scared. I cant eat or sleep or work.

What do you think i should do ? Do you think i can stop the pep? Is the test taken apon completion of pep atleast indicative ? 

What is my overall risk for hiv ? 

What wpuld you advise me ? If you feel i need to pay again i will happily do that. Please give me your opinion - i greatly value it



Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
I'm not sure precisely why you chose not to mention your earlier interaction with Dr. Handsfield.  if you had, you could have saved both you and me some time.  Further, it is now apparent that despite Dr. Handsfield's suggestions you have continued to take the PEP that was recommended against.  As you can already see, Dr. Handsfield and I have given you similar answers despite being unaware of each other's answers.  Repeating the questions does not change our answers.  I suggest you go and re-read Dr. Handsfield's original response to these questions.  EWH
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48 months ago
Dear Doctor

I seemed to have offended you in a manner that i didnt intend to . I apologise. Please allow me to explain

Actually i started a new question because the earlier question was closed and because I had another question about the syphillis after i saw the pimples on my hand and got worried about that.

Furthermore Doctor Hansfield asked me to check with my Doctor before stopping the PEP but i dont have a doctor as the only doctor i spoke to was the doctor in Switzerland in the emergency. I am now back in India and this is the only access i have to doctors. Quite frankly the doctor i went to In India said i dont have enough knowledge about this issueZ

Hence what was meant as a follow up question by paying the next time -  came to you and therefore i decided to get your opinion as well.

Im sorry if offended anybody . I meant no harm at all and was only looking for opinions of people - both Yourself and Doctor Hansfield - people i obviously respect ever since i started reading this website.

Im scared and worried and therefore without an obvious yes from doctor Hansfield i didnt stop the Pep and when i got this opportunity to ask you , i couldnt stop myself.

I hope you understand. 

Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
No offense was taken.  The issue is that our site strives to provide complete, comprehensive and personalized responses to questions.  Partial information stands in the way of that.

Regarding PEP, neither the clinician you saw in Switzerland nor Dr. Handsfield felt you needed PEP.   I feel the same way.  Hence and particularly if you are experiencing adverse effects from the drug, based on the information you have provided, I see no reason to continue to take it.  EWH
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48 months ago
Thank you doctor for your opinion.

Last clarification - as i mentioned i have a minute ulcer on my hand and a minute ulcer in my mouth. Iv just given a VDRl test a couple of minutes ago because its freaking me out. 

If it is syphillus - will it come out in the blood test ? Its day 18 today

Also if its not, could it be caused by the PEP or is it an ars symptom.

For any further questions i will pay again and start a new topic and mention the previous two conversations.

Thank you




Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Mentioned these ulcerations before.  While I have not examined you, from what you describe it would be difficult to attribute these lesions to syphilis.  If either of them were, I would expect your blood test to be negative. 

Ulcerative skin lesions are not a commonly described side effect of the medications which are used for PEP, not are ulcerative skin lesions suggestive of the ARS. 

As you have acknowledged, as this is the third reply to this series of questions regarding your very low risk encounter, I would hope that you will now be able to move forward without continuing concern.  This thread will be closed later today.

I would also remind you that the forum does not permit repeated anxiety driven questions by the same users. This will have to be your last one; future new questions on this topic will be deleted without reply and without refund of your posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tends to simply prolong such anxieties, when the real answer normally should be professional counseling; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.  EWH
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48 months ago
Clearly understood your policy doctor. will not ask more questions but im confused about your answer.

If either of my lesions are because of syphilis - it will come negative in my blood test ? Is it because day 18 is too early ?

In the firet reply you said it will come positive in the blood test.

I promise not to ask another question - no matter what your reply is . 

Thank you and apologies for being so irritating
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Sorry for your confusion. My message could have been misinterpreted, particularly by someone as anxious about their circumstance as you appear to be.  for that reason I will provide a clarifying response before closing this thread.

I anticipate that the VDRL test you mention will be negative because I am confident that the lesions you describe are not syphilis.  IF they were due to syphilis, your blood test would be positive but given the very, very low risk nature of your exposure, I anticipate that your VDRL will be negative and that you do not have syphilis.  EWH
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