[Question #2942] Follow up to question #2925

39 months ago
Hi doctor sorry to be back again it's just that I grew up in a very religious community and any information about std I'm getting online and I find you guys to be the most informative and trustworthy I just want to get some clarity. My first question is would an antibiotic cream like bactroban also mask std test or is that only oral antibiotics? 2) you said that my taking doxycycline would take care of syphilis now I don't have a clear understanding of all the stages of syphilis but let's say my first exposure of unprotected oral was in January or February of 2016 and I got it then although I know it's rare to get through oral  and for heterosexuals and I started the doxycycline in aug of 2017 it was a two month course not a four month course would it still be effective? 3) my exposures were from Jan 2016 to April 2017 if I do have it would I still be able to transmit it I don't have any sores and don't think I ever got a rash definitely not on the palm of my hand since I have a little health anxiety I would definitely realize that 4) Basically what's your expert opinion do I need to worry or based on my risks and medication usage can I stop worrying about syphilis and start my new relationship without worrying and enjoy it? 
39 months ago
Just want to thank you doctors again   for what you do here it is a great service!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome back to the forum, but sorry you found it necessary after the reasoned, science-based reassurance you had from Dr. Hook. I agree with all he said, including the low risk of this sexual exposure for any and all STDs.Unprotected oral sex isn't completely risk free, but it's low risk for all STDs and essentially zero risk for some.

1) No worries. No medicine of any kind have any effect on HIV testing, and no skin cream of any kind would influence STD testing.

2) Syphilis staging is irrelevant in this situation. Doxycycline kills the syphilis bacteria and if taken early, prevents the infection from ever taking hold. If taken later, as apparently in your case, it cures the infection, especially taken for a 2 month period. If you syphilis blood test is now negative, you can be 100% certain you do not have it, unless reexposed since completing the doxy treatment.

3,4) There was no signficant risk of syphilis from your more recent exposures. But if you are still concerned about it, have a syphilis blood test. If negative, then for sure you don't have it.

All is well. Do your best to stop worrying. Don't confuse your emotional rections to sexual decisions you regret with disease risks from those events. They aren't hte same. Deal with the former as you need to (counseling?), but you can disregard and forget the latter.

I hope this information helps you move on. Best wishes and stay safe.

HHH, MD

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39 months ago
Sorry there seems to be a misunderstanding 1) about the antibiotic cream I wasn't asking about hiv I tested negative for that I was asking about the test for gonorhea I know antibiotic can mask results was asking if that's only oral antibiotics? 2) I never tested positive for syphilis or negative  dr hook just mentioned that if I did have it the doxycycline I was taking for acne would take care of it my question was if my first exposure was Jan of 2016 and I took the doxy in aug of 17 for two month would that clear the infection if I did have it? 3) the staging was just a general inquiry if someone doesn't have sores or a rash would he still be able to transmit it and would it be likely that someone has it and never got a rash on his hand? Thank you sorry for the misunderstanding 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
1) Already answered:  "no skin cream of any kind would influence STD testing."

2) I also answered that. Re-read my reply above. The doxy would have cleared syphilis if you had it.

3) You cannot transmit an infection you don't have, and you don't have syphilis. Therefore the question about transmission of syphilis at various stages makes no practical difference in your situation. If your interest is intellectual, the answer is that syphlis is highly infectious in the primary stage, even more so in secondary, and then non-infectious once the secondary stage clears. That is, late latent or tertiary syphilis generally are not sexually transmissible to partners.

OK?
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39 months ago
Ok have one more question around 8 month before I was on this current dose of doxycycline which was 100 mg twice daily for two month I was on a dose of 115 mg once a day for six weeks since from what I read the recommended dose is 200 mg a day would it be possible that the 115 mg I took would make the syphilis resistant to doxycycline so when I took the right dosage it wouldn't cure it I know my exposure was low risk but just want to make sure in your medical opinion based on my risks and my medication usage is there any realistic chance that I would still be infected by syphilis? Thank you so much!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Treponema pallidum, the bacteria that causes syphilis, never becomes antibiotic resistant -- apart from some strains that are resistant to macrolide antibiotics (e.g. azithromycin and azithromycin). There is no such thing as doxycycline-resistant T. pallidum, regardless of exposure to doxycycline or related antibioitcs.

There is no chance you have syphilis. Believe it and move on with your life. 

Please note that the forum does not permit repeated questions on the same topic or exposure, especially when the questions are obviously driven by anxiety or when there is apparently difficulty in believing or accepting advice already given. This will have to be your last one; future questions on this topic or about this exposure will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce the temptation to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users’ anxieties, when professional counseling often would be a better approach; and because repeat or anxiety driven questions have little educational value for other users, one of the forum’s main purposes. Thank you for your understanding.


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