[Question #2234] Syphilis tricky question

47 months ago
Hello doctors, I think I put myself in a maybe irresoluble situation.


I had a risky encounter ( drunk sex with two CSW in a city brothel, don't remember if a wore a condon during vaginal intercourse; oral was unprotected for sure ).

I waited 3 months and I tested negative for HIV. Stupidly, I didn't test for anything else.

After the test I resumed ( protected ) sex with my partner. 

Two months later ( 5 months from the encounter ), because of a tooth infection, I had a week of amoxicillyn ( three grams a for a week I think).

Five months later, just by chance, I became aware of syphilis and I tested for it. It was a treponemal test ( quimioluminiscence ). I tested negative.

Then, about one month after the test, I got ill and I got a rash in the trunk and the palms ( just redness, nothing raised ). ( My child was also down with some viral illness ).  It lasted just one day.  I freaked out and when I had the chance ( two months more ) I tested again ---- negative again.

Given my testing history, I guess I'm syphilis-free, but I'm not completely sure about my partner because I've read that amoxicillin can cure syphilis and that some cured people will test negative even with treponemal tests. I know It's more common in HIV infected individuals and the ones who are treated when in primary infection ( which I guess I was not )

So, the questions:

1) is it possible that I catch syphilis, treat it with amoxicillin 5 months after infection and then testing negative 5 months from the cure ? And then, testing again negative ?

2) Should I get my partner tested just in case I infected her?


Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to the Forum.  I do not find this question tricky.  I see no realistic reason for you to be worried that you might have gotten syphilis, then cured it five months later without knowing you were infected by taking amoxicillin and, as a result, had your treponemal blood test become negative.  Syphilis is a relatively rare disease and is more likely to occur in men who have sex with other men than CSWs.  You give no history of typical syphilis genital lesions and the rash you describe does not particularly sound like syphilis.  Even if you had "treated" syphilis without knowing it by taking amoxicillin five months after your exposure, your treponemal blood test would almost certainly still be positive.  Most people with syphilis remain positive when tested for treponemal antibodies for the rest of their life- the small proportion of persons whose test become negative are persons whose syphilis is treated very early in infection, during the primary phase, not after the infection has been present for several months.  Thus my replies to your questions and suggestions are:
 
1) is it possible that I catch syphilis, treat it with amoxicillin 5 months after infection and then testing negative 5 months from the cure ? And then, testing again negative ?
No, this is simply not a plausible scenario.  See above.

2) Should I get my partner tested just in case I infected her?
I see no medical reason for you to get your partner tested. 

My advice is to put this all behind you and not worry further.  EWH

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47 months ago
Thank you for your answer Doctor,

One think I just remembered. 
While I was waiting for the HIV test ( about one-two months after the encounter ), one day I got enormously tired and feeling bad. It was just one day.
I remember because I thought it was HIV ARS.  I assume this doesn't change anything.

Regarding the lesions, I don't remember any but, to tell the truth, I wasn't particulary syphilis aware at the time so I might have overlooked it. Besides, I have a very long foresking. Is this relevant?

And the last thing, does the test taken after suffering the rash rules out  it was due to syphilis infection?

Sorry to bother you again but I see you have experience dealing with anxious people like me.



47 months ago
Ah, and one last thing. I didn't say before because I read it's not possible to have neurosyphilis symptoms with treponemal test negatives. But better safe than sorry.

I developed tinnitus some time after all  this horror. I blamed stress at the time; and effectively, once the stress was over the tinnitus slowly disappeared and , now that I'm worried again here it is again.

Maybe this could be relevant?



Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Correct, your episode o fatigue does not change anything. 

I you had a syphilis lesion you likely would have seen it and if you didn't you test would still be positive, as I explained.   similarly, if your rash was due to syphilis, your test would be positive.

Same answer about your tinnitus.  If you had neurological involvement due to syphilis, you would have a positive blood tests. 

Syphilis can cause a wide variety of abnormalities however all of those things can also be caused by many other problems and if syphilis were causing your problems, your blood test would be positive.  Please believe your test results.  EWH
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47 months ago
So, to finish this:

No worries of having been infected, then cured, and having infected my partner between infection and cure?

Thaks, you have been inmensely helpful



Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Correct, no worries at all.  Time for you to move forward without concern.

Take care.  this thread will be closed shortlyu.  EWH
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