[Question #3510] Single Protected Encounter With a CSW - Chances of Syphilis?

37 months ago
Dear Doctors,

Around the end of August 2017, I had a single encounter with a CSW in Germany (she was herself from Serbia). It started with about 2 minutes protected oral (I was receiving) and afterwards with the same condom we had protected vaginal intercourse for about 4-5 minutes. During this time I was rather nervous but did not observe any visible lesions or sores around her genitals. After that brief encounter, we stopped.

Since then I was extremely worried that I had contracted HIV. Therefore I got an HIV test once at 6 Weeks and again at 12 Weeks at the local clinic in my town in Germany where I live. Both tests were negative. Relieved, I moved on with my life. During this time, I did not notice any symptoms. No lesions, open sores, chancres, etc on or near my genitals.

In February this year, it occurred to me that I had tested negative for HIV. But I had not had a test for syphilis. Then about three weeks ago, I developed a small skin growth near my anus. Additionally, yesterday I had some pressure in my ears and a faint ringing in my left ear. I searched for these symptoms online and found that both skin growths near the anus and ringing in the ears can be a sign of secondary syphilis. This worried me a lot and I am contemplating now if I should get a syphilis test.

Based on your experience, do you believe that I might have contracted syphilis and if these are valid symptoms, although I never had an ulcer/chancre/open sore?

Thank you for your advice.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome to the Forum.  I'll be glad to comment.  Overall your risk for syphilis is VERY low.  Most syphilis occurs among men with male sex partners, not with contact to commercial sex workers.  Syphilis is transmitted through direct contact and thus if she did not have direct contact with your anus, it is unlikely that the growth you noticed was due to syphilis; rather, I suspect it could be due to some other process.  Further, although ringing in your ears could be due to syphilis, it is most unlikely.  Personally, I would have little concern about syphilis in your case and I suspect you have been misled by the internet.  If you choose to have a syphilis blood test however, at this time I can assure you that it would provide accurate results on whether or not you had contracted syphilis from the events you describe.

I hope his comment is helpful. EWH
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37 months ago
Dear Dr. Hook,

Thanks very much for your reply. I’m very glad to hear your expert opionion on the matter.

Just as a follow up: on the off-chance that I did have syphilis, how long does the treatment last and after how long can I have unprotected sex again? Thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
If you had Syphilis, treatment would be a single injection of penicillin.  We suggest that patients abstain from further unprotected sex for the week following treatment.  EWH---