[Question #3586] Syphilis

34 months ago
Good evening. I found out today that a guy i was with was diagnosed with Syphilis.  A week ago i had protected anal (bottom) and unprotected oral (giver). Oral was brief 10 seconds and no known exchange of fluids. 

My two questions is when should i test after this possible exposure and how significant is my risk. I do not have any symptoms currently.  

Thanks. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the forum.  To the bottom line first- I would recommend that you receive preventative therapy for syphilis following the contact you report.  The recommended therapy is penicillin injections, two of them given at the same visit for a total of 2.4 million units of penicillin.  While not emergent, getting treated sooner than later and preferably within the next week or so should be pursued.

Now for the detail.  Most single exposures to persons with syphilis do not lead to infection.  Current estimates are that, on average, the infection transmission rate is about 33%, i.e. one in three exposed persons become infected.  That you used a condom for your receptive exposure reduces your risk for infection somewhat but in balance, preventative therapy as described above is recommended.  You should be able to get this at your local health department.

Testing should occur at the time you are treated.  If your tests are negative, the therapy would be given as preventative therapy, OTOH, if the test is positive, then the same medication dose would be given for the purpose of treating the infection.  The absence of symptoms in no way changes this recommendation as the infection could be "incubating" and syphilis can be present without obvious symptoms. 

I hope this information is helpful.  EWH
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34 months ago
Thanks and I will follow advice.  With regard to activity was one more risky than the other for Syphilis?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
What a good question.  Both activities have been described as potential routes of infection.  If unprotected (I know it was not from your post) rectal exposure (receptive or insertive) would be riskier but your condom use moderates this (good job!).  Nonetheless, I would suspect that the rectal exposure was the riskier of your two exposures.  EWH
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34 months ago
Thank You
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Glad I could help.  Stay safe. EWH
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34 months ago
Sorry one more follow up Dr.  I spoke directly to individual this weekend and he says he does not have Syphilis or any other STI. I do not know him well and I’m still concerned. Would you recommend i still get shot or just test?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
If he has syphilis, you need the preventative therapy.  If he does not, testing is sufficient.  My question is why would you be told that you were in contact with syphilis if you were not.  sometimes people get embarrassed about having an STI and therefore deny it but on other occasions public health authorities warn close contacts of KNOWN cases.   Hard to tell what is going on here- perhaps there are more details.   Traditionally I would close this thread now that you have had three replies but there may be more to the story so I will leave the thread open in case you wish to make one more comment.  EWH
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34 months ago
I apologize for extra question and understand if you need to close. My understanding from a close friend is he had received preventative penicillin. I have scheduled appointment tomorrow. Does the public health clinic have an obligation to inform? How would they know? Can i ask? 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
The health departments typically address potential syphilis exposures with caution, reasoning that it is better to over treat than undertreat.  While I agree with this approach in general, it is also important that I acknowledge that they are not the ones who wind up with a sore rear end.  Sad experience has shown repeatedly that sometimes people who are not completely candid about their sexual histories as well and thus they  (health departments) sometimes treat close contacts of persons who, in turn, were in contact with other persons with syphilis.  The health department is obligated to tell you the basis for their plans to treat you but also should not tell you who the person you have been linked to is in the name of confidentiality.  Some persons they see have multiple partners 

I hope this all makes sense.  The thread will be closed shortly.  I hope my comments have been helpful and wish you the best.  EWH
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