[Question #2876] SYPHILLlIS PLEASE HELP.

42 months ago
Hello Dr.
To the point.  10/4 @2am had UNprotected oral performed on me by a transexual.  No obvious sores on her mouth.  10/8 UNprotected sex with wife.
I have HSV2 and on 10/9  @ 1 am I thought I was starting an outbreak. Pain in urethra, no discharge.  Noticed  red bump on penis just under the head.  I assumed it was beginning of out break.  Went on line and saw all the other possibilities.  Freaked out and went to clinic on day 7, who took urine and blood and sent out. also gave me 1 gram azrithomicin and shot of ceftriaxone.
3 days latter all tests neg.  Worried about NGU still as the pain continued.  I thought might be viral since there was pain and no obvious discharge at that point.  Started Valacyclovire and after 8 days pain almost gone and bump gone after about 6 days
13 days post exposure back broke out into rash lower back side and moved up to shoulders, several  bumps on abdomen I'm various places as well on.
1- could this have been syphilis chancre after only 5 days?
2. could I have secondary rash after 18 days post exposure???  The rash was itchy and burned and seems to have subsided after 24 hours, light pink ish spots but seemed to be calming down
3. Would the antibiotics have prevented Syphillis? I read that if primary already there is a different courses of treatment.
4. Would the anti boitcs have just slowed down the symptoms or made them less noticeable?
5. the past week have had a low-grade fever of 99
6. since the was no notce bump on penis when had sex with wife, assuming it is syphilis, would I have infected her?
7. Can syphilis happen this fast??????  
8.  If I took a blood test now, assuming that this is secondary stage, would the test be reliable even after only 19 days post exposure.
I would really appreciate your help I am extremely anxious over all of this and the possibility of loosing my family.  I can't sleep or eat.  It is extremely hard to explain to my wife why I seem off.  
Please your prompt reply would be appreciated.
thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your interesting question.

On one hand, you are right to be concerned about syphilis. While there are few data on syphilis incidence in male to female TS persons, many of them align with men who have sex with men (MSM) in partnership patterns and syphilis risk. (Syphilis is currently uncommon in heterosexuals in the US, dominantly a problem of MSM.). OTOH, the large majority of such persons don't have transmissible syphlis, and the risk of syphilis is generally low from oral sex. And as you suggest yourself, 5 days is too soon for onset of chancre and your symptoms in general are not typical for syphilis.  And as you suggest yourself, ceftriaxone for sure would have aborted incubating syphilis and azithromycin probably would do so; they definitely prevented you from getting active syphilis.

You're the best judge as to whether you might have had a recurrent outbreak of your HSV2 infection. This can cause urethritis, but if it hasn't done so before, probably that's not the explanation now. The timing and the symptoms, including urethral pain, also would fit with a new genital HSV1 infection -- and HSV1 is among the most common STDs from oral sex and an occasional cause of NGU. Also, recurrent HSV2 would rarely cause symptoms that last 10+ days, whereas a new infection with HSV typically does so. The apparent improvement with valacyclovir also tends to support herpes (although it's also possible it would have cleared on its own over the same time frame.) In any case, I think it quite likely that you now have dual genital herpes, with both HSV2 and HSV1. (But if so, it probably won't have much impact in the long run. Genital HSV1 usually recurs infrequently if at all and there isn't much asymptomatic viral shedding, hence low risk of sexual transmission to partners.)

I'm not sure what to make of your skin rash. It definitely started too soon for secondary syphilis. Depending in the nature of the rash, I would wonder whether you had a condition called erythema multiforme, a generalized rash often triggered by HSV outbreaks or initial infections. (EM is not herpes itself, but an immunologic reaction to it.)

To your specific questions:

1-3,7) Answered above.

4,8) There is no chance of simply suppressing syphilis with these antibiotics or delay in test results. You'll never have a positive syphilis test from these events. Technically, it won't be possible to know whether you never had it or if you were but the infection was nipped in the bud. But in any case, you don't have it and were never infectious for a partner. You could be tested for it (6 weeks after the exposure), if you would like further reassurance. But you definitely can expect a negative result.

5) 99F really isn't a fever -- healthy people have occasional temps that high. If you have or had fever at all, it fits better with new HSV1 than anything else.

6) No realistic chance it was syphilis -- see above and no. 4. (However, if your wife has not previously had HSV1, e.g. oral herpes/cold sores), you could have transmitted it to her. You likely were highly infectious at the time, if indeed it was herpes.

I hope these comments are helpful. Let me know if anything isn't clear.


42 months ago
Thank you DR. Hunter I appreciate it your prompt reply

To follow up,
1. It is impossible for the Chancre to appear that soon?
2. It is impossible or unlikely for secondary Symptoms to appear this soon?
 3.The treatment I had at day 7 would have sufficiently stopped/cured the infection should I have had one?
4.  I most likely was not infections with Syphilis at day 4?
5. The blood test I took today if, I had active infection and showed positive or negative, would be accurate?
6. With symptoms could the test be correct if negative?

 My wife and I both have HSV2 for many years.  I assumed I picked up NGU or I was having an outbreak or both.

I have been a mess since this happened and I am thankful for your quick reply.  just want to sort this out and hope for the clarification.
42 months ago
Sorry Last question

You said prevented me from getting "active Syphilis, can you explain?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
1-4) Repeat questions:  1) exceeindgly unlikely, and a it doesn't sound like a chancre, 2) yes impossible, 3) yes for certain, 4) impossible for syphilis to be transmissible before an overt (open sore) chancre appears, rarely if ever before 10 days.
5) A blood test today would be meaningless. If positive, it would have to be from some more distant past infection. If negative, it won't tell whether you never had it or were exposed but cured before the infection became active or transmissible.
6) Not sure I understand this.

I continue to believe there is a good chance you acquired HSV1. Re-read my reply above. I agree you may have had NGU, but NGU is caused by HSV fairly frequently. I continue to believe it likely that you acquired a new HSV1 infection from the oral exposure. (Note that HSV2 is not the same as genital herpes. The numbers refer to the viruses, not the part of the body infected. You likely how have both HSV1 and HSV2 genital herpes.)

By "active" syphilis I mean infection that can be transmitted and is causing symptoms. Treating syphilis before it becomes active cures it before symptoms develop and before blood tests can be come positive, and before it can be transmitted.

Bottom line:  You can stop worrying entirely about syphilis. No chance. But do pay attention to the possibility you now have two genital herpes infections. The new possible  HSV1 is a more important issue than syphilis.

42 months ago
Thank you SO Much.

OK, reading your response last thing 

What if the sore was on day 7 when I go the shot?  I can't be sure what day I noticed the bump.  If it was already a chancre and the shot was given would it still stop the infection?  You answer confused me a bit.  I know I got the shot day 7, but I can recall for sure what day the bump was noticed.  

What I meant by :
6. With symptoms could the test be correct if negative?  

Is that if I AM having symptoms ( I know you are saying no) but if my time from shot to bump is off and the test comes back negative can I be assured that it is accurate?

That will be my last question.  Thank you again for all your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
 You're really overthinking this. Syphilis simply is not an issue. Let it go! ---