[Question #3349] Syphilis risk/testing

90 months ago

Hello,

I am sorry to be back so soon. Dr. Handsfield was previously very helpful, I just have a new concern that I previously did not consider.

I am a young, straight female. Six + weeks ago now, I performed brief unprotected oral sex on a man who is an aquatintence of mine. After this occurred, I was immediately regretful and expressed this to my doctor - I was tested for Clamydia, Gonorrhea, both were negative. Just a few days ago, I had a 4th gen HIV test done, that was also negative. Ever since this happened (and even though I realize it wasn’t likely), the HIV was my major concern, so the nearly 6 week negative result there was certainly a relief.

One thing that I did not consider, unfortunately, was syphilis. I began looking into it and in a way, I’m sorry that I did. I’m wondering how much of a risk I truly did have. His “area” down there looked completely fine, no visible sores or anything. I can’t say I have really noticed symptoms in myself (chancre) but I’ve started focusing on my mouth and being overly observant with any little thing that may look/feel off. About two weeks ago, I did feel like I had irritation and maybe a little “puffiness” at the tip of my tongue on the right side, but within a couple of days, it subsided.

More than anything, I would like peace of mind. After looking into syphilis testing, it appears to be a little bit confusing and different sources recommend different ways to go about it. If I were to go for an RPR screening test, at this point after 6+ weeks, is that a reliable test? If the result is negative, is there any need for further testing?

90 months ago

Additionally, for what it is worth, I have done the same exact thing with the same man previously, a little over a year ago. I ran and got tested (I don’t recall if syphilis was included), and again, everything was fine and has been fine since then. I don’t think I necessarily believe he has something to catch as much as I feel guilty about what I’ve done (I am in an otherwise committed relationship). Now, to have done it again, I’m very disappointed in myself and am realizing this anxiety is NOT worth it. Being able to put it all behind me ASAP is what I am trying to do.

H. Hunter Handsfield, MD

90 months ago

Welcome back, but sorry you found it necessary.

Syphilis is about as unlikely as HIV in this situation. Further, as you seem to know already, if you had acquired syphilis from this event, by noew you would have had a chancre (open sore) on or in your mouth. The "puffiness" you describe doesn't sound at all like syphilis. But the answer to your direct question is yes: a negative RPR at this time will conclusively prove you didn't acquire syphilis during that exposure.

Both your previous thread and this one suggest that you have an inflated view of STD risks, especially from oral sex, and you also have a lot of self awareness about your anxiety over some sexual decisions you regret. Perhaps you could reduce it by speaking with your partner for reassurance he has no STDs and is not at risk. Or perhaps for him to be tested: if he has negative results for HIV and syphilis, you'll know for sure there was no risk.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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90 months ago

Doctor,

Thank you again for the information.

I have no reason to believe that the man who I’ve performed the brief oral on has anything to catch. My biggest fear is passing on something to my regular partner, who I know is clean. This is the reason why I’ve been as (overly?) concerned as I am.

Another question here. When I first went to my doctor after this experience, I was sent for chlamydia & gonorrhea testing, done by urine sample, which came back fine. How common of a thing is it to see chlamydia/gonorrhea of the throat? I don’t imagine that would show in a urine sample. Should I be concerned about it? Before stumbling upon it online, I didn’t even know that was possible. I can’t say that I’ve experienced any kind of bad sore throat since this has happened, although according to what I’ve read it could sometimes be asymptotic, which to me is a little scary. Given that my doctor knows that oral sex is what went on, I am surprised he didn’t mention this at all to me, but rather sent me for the urine tests. Just wondering if it is rare or more common than I’m aware of.

H. Hunter Handsfield, MD

90 months ago

Gonorrhea infects the throat fairly commonly, but chlamydia rarely does. However, even gonorrhea should not be a worry here: urethral gonorrhea is rare without symptoms, so if there was no obvious urethral discharge visible in your partner, the it's very unlikely he had it. Oral gonorrhea usually causes no symptoms at all; absence of sore throat says nothing about the chance you were infected. I agree it didn't make much sense for your doctor to do a urine gonorrhea test; it suggests s/he isn't fully up to speed on STD risks and testing. In any case, the chance you have it is zero for all practical purposes and I don't recommend testing. But if you want confirmed reassurance, a throat swab is necessary.

Oral chlamydia testing is rarely done. There are no approved tests and it's a rare problem anyway, causes no symptoms, and has never been known to be transmitted to oral sex partners.

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