[Question #3950] Final follow-up to #3298 - MSM oral sex, syphilis and HIV risk

34 months ago
Dear Doctors,

This will be my final follow-up. I got a call from the sexual health clinic today, advising me that my test results from last week (tested 10 days after unprotected oral sex with a man who told me he had been diagnosed with syphilis - I was treated with penicillin at the time of testing) were negative for syphilis, HIV, and gonorrhoea. 

The nurse I spoke to said that they wanted me to come back in in 3 months for confirmation testing. When I asked whether there was any chance the syphilis hadn't been cured, she said no, that it was to confirm whether or not I had actually caught syphilis this time around. I have tried to understand this, but I am hoping you can clarify for me...*if* I had syphilis and I was successfully treated for it before it manifested any symptoms, is it still possible that I could test positive for it (I assume this would be antibodies) in 3 months time, or have I misunderstood?

I also asked whether follow-up testing would involve screening for HIV, and the nurse said no, as the unprotected oral sex I engaged in was considered a low risk activity. This was my suspicion having done some research (probably too much research) online, but I was just wanting to confirm that you agree with this judgment, and that you would consider me safe to go back to having sex with my partner without fear of infecting him?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome back to the Forum.  I'm sorry that your anxieties over this exposure continue to trouble you.  On this occasion I will be addressing your questions.  In preparing to do so I reviewed both of your earlier interactions with Dr. Handsfield and agree with all that he said. Your risk for syphilis room your oral exposure was very low and the receipt of penicillin would have entirely eliminated any chance that you were going to develop syphilis lesions.  it is past time for you to put your worries behind you and move forward with complete confidence that you did not get syphilis from your exposure. 

The nurse's choice of words was unfortunate.  The penicillin treatment that you received would have eliminated any chance of developing syphilis lesions.  The follow-up blood test which was offered was really not necessary in terms of your prior exposure although we are learning that some persons who are exposed to syphilis can be exposed on multiple occasions.  In this case, unless you have additional risky exposures you need not worry.

As per HIV, acquisition of HIV from unprotected exposure is extraordinarily rare.  I have never heard of, nor seen a person who acquired HIV from receipt of oral sex and risk for acquisition of HIV from performing oral sex on an infected person is so rare as to be a medical oddity.  Even the most conservative estimates suggest that, IF your partner had HIV, your risk for acquiring infection from performing oral sex is less than one in 10,000 and probably lower.

I hope my comments, and reiteration of Dr. Handsfield' s assurances will be calming and allow you to move forward without concern.  You really need not be concerned.  I must however also warn you that repetitive, anxiety-driven threads may be closed with little or no response and without return of your posting fee.  Thus one this exchange is over, I trust there will not be a need for further new threads.  EWH
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33 months ago
Thank you Doctor, that's reassuring. So if I'm reading you correctly, if you were silly enough to be in my position, you wouldn't be too concerned about additional HIV *or* syphilis testing?
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Correct, at this pint I would be moving forward without continuing concern.  EWH
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33 months ago
Hi Doctors,

I know this is my final question. Although I am back here, I have done well to put my worries aside over the last few weeks. The one thing I wanted to check back on is an emergence of very small pimple-like bumps around my collarbones, for no apparent reason; some of them have produced pus when I squeeze them. I understand that I received treatment for syphilis but I wondered if there was any research into the success/failure rates for treatment, and whether such pimples/rash could be a sign of a secondary syphilis rash? It is now about 6 weeks after my exposure. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
The rash that you describe in now way is typical of syphilis although certainly clinical evidence of syphilis can be highly variable.  The preventative therapy of syphilis with penicillin such as you received is virtually 100% effective.  I realize you are very nervous about the exposure you have described but the chance that this is syphilis is negligible.  If you feel you must prove to yourself that you do not have syphilis, a test at this time will be entirely reliable.  If your rash is syphilis, the test will be positive.  I am confident the test will be negative if you choose to test.. 

As you point out, this is my final response to your questions.  The thread will be closed in a few hours without further answers.  Please do not worry.  EWH
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