[Question #409] Syphilis Positive from Receiving Oral - HIV Risk?

92 months ago
During a routine STD check that included Hep B, Chlamydia, Gonorreah and Syphilis i tested positive for Syphilis from a VDRL test

I have had 14 unprotected blow-jobs from girls as i am heterosexual and 2 acts of cunnilingus during the last 12 months.This is the extent of my sexual activity.  This consensus says Syphilis is rare but is possible to transmit orally and HIV is not a concern. I am an expat working in Mozambique so i don't know if syphilis is more common here. 

My worry is if i contracted Syphilis earlier and received an unprotected blowjob at a later date does this increase the risk of me acquiring HIV if receiving oral was my only exposure? I must also mention that nothing physical alerted me to that fact i had contracted syphilis - i had no chancre or sore in my penis or any symptoms of early stage syphilis. I did develop a tiny white spot similar to a canker on the back end of my tongue, the doctor who inspected said it may have been the entry point but the only way i can see this happening is through deep french kissing or possibly cunnilingus?

According to my doctor who did the test he said Oral is not a risk for HIV even if i received a blowjob while i had contracted syphilis because blood needs to be present to transmit HIV and Syphilis can be contracted with contact with a lesion. Is this a true opinion? Can i just continue my Syphilis treatment and not worry about HIV?

An update - a week after the penicillin shot and Doxy medication (prescribed for 10 days) i took a TPHA test for syphilis which came non-reactive. Does this mean the medication worked and i am clear or was the first round of VDRL testing a false positve? The doctor who did the TPHA says its conclusive. As i said i never had any physical or chancre like manifestations except for that canker in my tongue. Is it likely that i even contracted syphilis to begin with?

Thanks for your time and patience on this - we don't have STD experts here so i wanted a clear answer
H. Hunter Handsfield, MD
92 months ago
Welcome to the forum. Thanks for your qeustion.

As you suggest, your exposures were indeed low risk for syphilis, and probably you would have noticed symptoms (the chancre) if you had caught it. But that's immaterial. Your blood tests show you do not have syphilis and never did. The VDRL commonly gives false positive results. Nobody should ever be diagnosed or treated with syphilis based on VDRL alone; it always requires a confirmatory blood test. One of the standard confirmatory tests is TPHA. Once positive, TPHA is positive for life. To that extent, the doctor you saw is correct -- the negative TPHA is conclusive. Not because you were treated successfully, but because you never had syphilis.

I agree with your doctor about oral sex carrying little or no risk for HIV. No worries there.

Once someone has a false positive VDRL test, it often remains that way for life. Just so your prepared for a similar outcome if tested again in the future. If syphilis ever is suspected again, you should have one of the newer IgG tests, and not VDRL or RPR.

I hope this has helped. Best wishes and stay safe!  HHH, MD

92 months ago

Hello Doctor

Many thanks for your response –

I have one last follow up question

I do a full STD panel in December every year

In December 2014 I did a full STD panel which included HIV since I had an issue with a condom break mid-year and it was negative for everything including Syphilis. I am not sure what Syphilis test they used but it was a rapid test and my last sexual exposure of any kind was in September of 2014 so I feel the timeframe for testing was correct

In December 2015 I did a full STD panel except for HIV since I only engaged in receiving blowjobs in the last 12 months. This was done at a different clinic which they used the VDRL test for syphilis and came positive.

My question is this – does the VDRL test have a reputation for false positives or did it come as positive because I may have an underlying condition or other STD?

Even the doctor who performed the TPHA test was surprised VDRL tests are still being used at other hospitals.

Thanks again – this will be my last question 

H. Hunter Handsfield, MD
92 months ago
The nontreponemal syphilis blood tests (VDRL, RPR, and a few others) indeed "have a reputation" for causing false positive results; there's even a name for it, "BFP" ("biological false positive"), which goes back to the very first syphilis blood tests over a hundred years ago. This is nothing known. The reason for any particular individual's BFP usually is unknown. Once it a while it's a sign of an underlying autoimmune disorder, but if you're having no unexplained symptoms of such a problem (such as certain kinds of arthritis, skin rash, unexplained fever), it's probably unlikely in your case. Anyway, this is why my initial response said that a these tests NEVER are considered adequate by themselves to diagnose syphilis -- with even heavier emphasis on NEVER. Your doctors should not have diagnosed syphilis and should not have treated you before doing a confirmatory test to confirm the VDRL. (I usually try to avoid criticizing persons' physicians. But this is a hard and fast rule for over a century that is known, or should be, by anybody involved in STD care.)

There is no basis for "surprise" that VDRL testing remains the norm in many settings. In recent years, new rapid tests have become available and now are used routinely by many labs, hospitals, etc. However, these tests also are not perfect and have their own problems, and syphilis experts debate which type of test should be used routinely in different settings. Some of those experts continue to favor VDRL or RPR. So I see no legitimate basis for your doctor to be "surprised" by it.

Does that clarify things? Let me know if anything remains uncertain. You are entitled to one more follow-up comment/question.

92 months ago
Hi Doctor

Many thanks for your clarification - really helps ease my mind. Misdiagnosis is frequent here as most doctors are GP's and not specialists hence why i scouted this forum. I always had the nagging feeling that there was no way i had contracted Syphilis but the wrong diagnosis was hell to go through both from an anxiety perspective as well as the medication side effects and not to mention the very painful penicillin shot. All in all it was a bad Xmas holiday. 

Since i received the penicillin and doxy medication do you feel like it could have any adverse side effects on me as i was wrongly diagnosed? I did feel quite nauseous the next day after the shot and developed a sinus infection - no fever though. Its all clear now though

I guess what i want to be reassured with is that in your opinion can i put all this behind me? Based on my exposures in the last 12 months would you say i have the all clear until my next routine testing? I always play safe - i have refrained from acts like intercourse because i don't want to risk issues like a broken condom and have to go through the stress. 
H. Hunter Handsfield, MD
92 months ago
Sorry you received the unnecessary treatment. (That you were given both penicillin and doxycycline is further evidence that your doctors are not up to speed on syphilis. There is never a need for both of them; penicillin alone always is sufficient.) In any case, the antibiotics won't caus any harm.

You definitely can put all this behind you. And I would recommend against continuing annual tests, as long as your sexual exposures don't change. You're at too low risk to take the chance of additional false test results. But if you do continue such testing, request a syphilis test other than VDRL or RPR, such as the T. pallidum IgG test.