4 weeks ago, while very drunk, I was offered a massage from someone outside a massage shop in Hong Kong. 

I had a back and then a foot massage and during that I dozed off.

I suddenly woke up to find the lady trying to give me unprotected  oral sex, she had my penis in her mouth. My penis was erect.

I stopped her and left. This is not the thing I am interested in, ever.

My issue is that I have no idea how long she was doing this to me for. I did not orgasm.

The next day in the office, I checked the internet and self prescribed myself 1g of Azithromycin and 2g of Flagyl in one dose.

The following day I then took a further 2g dose of Azithromycin in one dose.

8 days later I took a full std panel and everything was negative.

I had sex with my wife on the 8th night post incident.

I then read about syphilis on the 12th day and realised that it would not show positive until much later.

On the 3rd and 4th week I did the VDRL and RPR (igg/igm). Both negative.

I am waiting for 6 weeks to have another test.

My issue is that you read so much conflicting information that I am making myself sick with worry. I need to tell my wife what happened but I need to have the test results back as I don't want her to be worried while waiting for the results.

Thus. 

1. How reliable is 4 week test result?  The doctor told me that quite reliable.

2. How reliable is a 6 week test result?

3. Would the medication I took prevent syphilis from incubating?

4. How easily can someone get syphilis from such an exposure.

5. Is my wife at risk from when we had sex 8 days post the incident?

thanks for your help.

Welcome to ur Forum.  I'll be glad to comment.  The short answer is that, based on the sort of exposure you had, the medications you took, and your test results you have nothing to worry about.  More details and facts can be found in my responses to your specific questions below:

Thank you so much for your response. You have certainly calmed my nerves and have had a significant positive impact on my mental health.

I understand the potential exposure, in terms of statistics, is extremely low. Perhaps as low as 1 in a 1000. Being an Actuary by trade, i have comfort in numbers, unfortunately, statistics on syphilis are not something I would like to access via work. Would that be a reasonable percentage chance? 

I understand that syphilis does not lend well to oral transmission and the vast majority of cases are in MSM.

I understand that the 4 week test is early and potentially reliable and that a 6 week test would be as good as conclusive.

My only further query is about your response to the potential of passing any infection 8 days after potential exposure. You said 'No'. 

Would it be possible for you to elaborate on your response and explain why on 8th day (explicitly the 8th day) after potential exposure, it is not possible to pass syphilis? Is this due to the incubation lifecycle of the bacteria? Do chancres have to be present? When does a first time infection become transmissible? 

I ask this as when I spoke with my doctor, he did not respond very well when I asked about potential exposure and the ability to pass any potential infection through intimate contact with another on the 8th day. Instead he recommended weekly testing for the foreseeable future due to the high probability of being infectious from day one of infection if I have been exposed. To be fair to the Doctor, Syphilis did not seem like a regular topic for him.

Also, the information on the internet from sources such as the CDC just say it is highly contagious and do not give any time frames. I guess overly conservative to cover all possibilities.

Again, Thank you for the response and your assistance. You are of great value to society and your Doctor/ Patient manner is amazing. Your ability to ease a troubled soul is remarkable.

I shall take the 6 week test as I have it booked, but I am highly confident that I am not infected. 

Thank you.

I think your assessment of being infected being less than 1 in 1000, considering all the information you have provided, I would estimate your risk for infection as being less than one in 10.000 or even lower. 

Regarding your question about the possibility of having transmitted an infection, if present, I would first point out that there is not evidence that you were infected thus you could not transmit infection.  Secondly, syphilis is transmitted by direct contact with infectious lesions and since you did not experience lesions, once again, I feel confident that there is no meaningful risk that you transmitted infection to your wife during the exposure you describe. 

I hope that these comments clarify things but if there are further questions, please feel free to use your final follow-up to seek clarification.  EWH

As per your observation and prediction, my 6 week test came back negative for the VDRL and RPR. Based on this, I assume that no further testing is required and I can consider the case closed.

I would like to say that I had complete confidence that this would be the case thanks to your professional experience and your excellent mannerisms.

I have read many of the questions on the site that many people pose, quite often it appears to me that many of the questions are posed on the back of anxiety compounded with an inadequate understanding of the mechanics of STD transmission and symptoms. My understanding of your response in these matters is simply that your responses are based on absolute expertise on the subject matter and the many years experience you have had operating in the field. 

Since I opened this thread, there have been times when anxiety has surfaced. I found the most simple solution to deal with the anxiety was to re-read the responses that you made with reference to my representations. You calmed me and drove away the anxiety demons.

Thank you Dr. Hook, thank you for helping me get through this difficult time.

Please go ahead and close this thread.

Thanks very much for your thanks and for letting me know that my comments helped you to address your anxiety.  I think your comments regarding the profound power of anxiety related to STIs is right on target and certainly a major part of our efforts is to help clients overcome their concerns with scientifically based knowledge.

Your 6 week results are definitive.  I'm pleased that you will now be going forward without further concern.

This thread will be closed later today.  Again, thanks and stay safe.  EWH