[Question #4036] MSM syphilis

31 months ago
Hello

About 6 months and 3 weeks ago i performed unprotected oral sex and recived condom protected anal sex. Before and after sex I asked about STD status, he said he was tested 2 months prior and had nothing. Pluss he allways used protection for anal.
First and last time I've had sex.

At 4 weeks i got tested for everything by my doctor. All negativ, so I ruled out clamydiah and gonoreah. 

In my city there is a free screening program for MSM, where you can get a rapid test for HIV and syphilis. I have been going there alot since my exsposure. I tested negativ after 2 months, 3 Months, 4 months, 5 months and 6 months. But I have a feeling that I have syphilis.

I have been looking for the chancre but I have not seen it.

What I'm wodering about is first of all the prozone effect. I' ve read that as much as 2% will trigger the prozone effect( or hook effect, is that credited to Dr. Hook?) will the effect dimish over time? Would my inital fals negativ turn positiv as the antibodys dropped?

About 6 months after the exsposure I got Dermatographism, I can't find a link between this and syphilis, but syphilis can present as everything? Do you belive this can be related? I have not noted any other rashes, and I've been looking! 

Lastly, I've had alot of canker sores latley(4months). Even some on the side of my gums. But they have heald in 7 days or less, so my dentist hasent seen them... Could this be secondary syphilis?



31 months ago
Just on of my follow up questions, if it's okey.

The place I have been getting the rapid syphilis and HIV test is made to lower the treshold for getting tested. So it dosen't look like a medical fasility at all. They have couches and coffee and it's just like a lounge. But i've been thinking about the light there. Because even if it's like well lighted living room it's nothing like the sharp light of a excamination room. Could this cause the people doing the testing to miss weak positiv tests? Is there any guidelines for how much light you need to read this type of tests?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome to the forum. Thanks for your question.

The blood tests for syphilis are 100% reliable in detecting early infection. Perhaps you have read that screening tests (e.g. VDRL, RPR) can be negative in longstanding syphilis. That's true, although rare if no treatment has been given. However, these tests always are positive within a few weeks in persons with newly acquired syphilis. In addition, it is uncommon to acquire syphilis without an obvious chancre (usually a painless but otherwise very obvious sore) at an exposed site. Notwithstanding your "feeling that I have syphilis, the combination of no symptoms plus the negative tests you had prove for certain you did not acquire syphilis during the exposure described. 

I am not aware of dermographism as a manifestation of syphilis. If it happens, it would be part of a generalized skin rash of secondary syphilis, which unequivocally you do not have. And canker sores are not typical for syphilis either. The blood tests are infinitely more accurate and reliable as syphilis indicators than any and all symptoms you might have now or in the future.

As for the venue where you were tested, I'm not sure I understand your concern. The rapid syphilis tests are highly reliable and quite simple when performed as directed. Obviously, they can't be done in a closet or completely dark room. But your testing to date has been quite excessive, and there is no chance all those tests would be falsely negative. But if you have any remaining doubts, you could have a final standard, lab based test. If you do that, you can expect another negative result.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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31 months ago
Thanks for your answer

The tests have been rapid test. Sandwich immunoassey tests giving the result in 10 minuts. I understand that these are among the tests where you can get the prozone effect. Is this wrong?

Also if you don't mind. The light question is becuase the tests are read on sight by looking for a test line. If this line was very faint you could need suprem lightning to see it? Or are the test more obvious than that?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
I am not aware of any data on prozone with the rapid tests. But based on the immunochemistry of the test, I very much doubt prozone is a problem. There has never been a scientific report of it, that I am aware of.

I can't speculate on how good the lighting has to be. But I think your anxieties about this are influencing your judgment. I can't imagine anyone would attempt the test if lighting were not sufficient to see even faint lines. But as I said above, you are free to seek a standard lab based blood test if you remain concerned about it.
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31 months ago
Hello again doctor

I am trying to not to more testing as I don't believe that I will be comforted by more negativ results. This seems to be all in my head unfortunatly.

I have been doing some more reaserch and I found in CDC guidelines for rapid testing that if you can read a newspaper with fontsize 12 next to the test the lightning is good enough to performe the test. I did read a newpaper next to the test so I do belive that it showed negativ.

As for my oral ulcurations, I have found nothing, not even a singel case syphilis study with my symptoms. I do know that it's not proof that it can't happen. But when i put all the numbers togheter it seems very unlikly that it would be syphilis. 

My city with 600000 has by my calculations 6000 msm(but it could range from 3000-40000) so far this year it has been diagnosed 24 syphilis infections in men. And almost 300 gonorreah infections. Wich would say alot of unprotected sex. The test was supposudly over 99.8% relaybel. And from all the tests i've taken I think the number is even higher. Lastly without a rash or loss of hair or syphlis related mucosal ulcers. I would put my chanse for syphilis in the 1 to many million range. 

So thanks for the help doctor, and if I have syphilis I will most defenitly play the lottery.

Just on last question. Is the hook effect credited to DR Hook?

Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
More overthinking and over-interpreting online information in absence of sufficient understanding. I'd suggest laying off the internet or trying to calculate the chance you have syphilis in the face of the incontrovertible evidence you do not!

I was previously unaware of the term hook effect, but on quick online search, I'm sure it's not named for our Dr. Hook. Maybe his dad, who was a nationally prominent infectious diseases and internal medicine specialist of the 1050s to 1980s, but I doubt that as well. It doesn't seem to usually be capitalized and probably not named for a person, as best I can tell.

I hope the discussion has been helpful. Best wishes and stay safe.
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