[Question #4133] Syphilis Risk

32 months ago

Hi and thank you for the service you offer.  My question is in regards to sti risk.  About a month ago I received unprotected fellacio from an African American stripper in Atlanta.  I only make the destination because I have read that stis, especially siphilus are in the rise in this community and this area of the country.  A few questions.

 

1). What would you say the chances are that I was infected with siphilus.

2). I got an sti test at 2.5 weeks (all negative).  Does this mean anything for siphilus?  What about other stis?  If I were to retest at 4-5 weeks for siphilus, would t mean anything or should I wait till 6 weeks 3). Can you give siphilus to others before a sore becomes apparent 4).  Assuming you are looking for one on your penis, is a siphilus sores always noticeable (eg large open sore like you see on the internet).  I have a few blemishes (look like small pin size pinples) which showed up a few days ago, so wondering if this is any way could be siphilus.  Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum. Thanks for your confidence in our services.

I'm not familiar with the details of syphilis frequency in Atlanta, although I have seen reports that DeKalb and Fulton counties have especially high rates. However, as in most large urban areas, the large majority of cases continue to occur in men who have sex with men. While southeastern urban areas generally have higher rates in heterosexual men and women than, say, Seattle, Denver, or Chicago, cases remain infrequent in women, even in sex workers. Rates are much higher in African Americans than in other racial/ethnic groups, but still no common in women of any race. That's not to say the stripper could not have syphilis; of course it is possible. But the odds any such person is infected, and that she has active infection in the mouth or throat and thus could transmit syphilis by oral sex, is extremely low. With those background comments, now on to your specific questions.

1) I would guess well under 1 chance in a million you would have acquired syphilis from this event.

2) 2.5 weeks is too soon. In general, the syphilis blood tests become positive starting around 2-3 weeks and are always positive by 6 weeks. So your negative syphilis blood test is valid as a baseline, i.e. to know you didn't have syphilis before this event. But it says nothing useful about whether or not you were infected during that event. Testing was also too early for all other blood tests, including HIV. (But HIV is almost never acquired by oral to penile exposure, so that risk was virtually zero anyway.) If you want a conclusive syphilis blood test, retesting at 6 weeks is exactly the right time.

Assuming you had a urine test for gonorrhea and chlamydia, those results are 100% reliable and prove you weren't infected with either one.

3) Syphilis cannot be transmitted to others until symptoms begin, i.e. the chancre (open sore) of primary syphilis. Since nothing like that has shown up on your penis, you can safely assume you have not been infectious for your own partner(s).

4) Some chancres are hidden, i.e. not easily seen, but that's not likely on the penis. The "blemishes" you have seen are not chancres.

Bottom line:  Between the low risk of syphilis in the stripper, the even lower risk she had an active oral infection, and your lack of symptoms, you can be very confident you didn't acquire syphilis. But for confirmation and reassurance, have another blood test 6 weeks after the event.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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32 months ago
Thank you for your very thorough response, as it has done a lot to ease a bit of anxiety I am feeling.  Some additional follow up questions.

1). I happen to be on cirpoflaxin for another issue.  Would this in any way be masking any symptoms of a potential syphilis outbreak (and/or cure any stis which are present).  
2). Given my negative test for ghon/chlamidia, and the less than 1 in a million chance of syphilis.  Should there be any legacy concerns on any stis.  I have not had any other traditional symptoms (ie herpes sores, penis discharge, etc.). I have noticed that the head of my penis is a little red and that it is somewhat sensitive and irritated, but I have not seen this described as a normal sti symptom.  Could this be a concern for sti?  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Ciprofloxacin has no effect at all on syphilis, and no effect on blood test results. It would prevent infection with most strains of gonorrhea if you were taking the drug at the time of exposure. It might have some protective effect against chlamydia, but not reliably.

I'm not sure where you read that a red, sensitive, or irritated glans (head of penis) suggests an STD, but I disagree. Such symptoms are generally due to non STD skin conditions.

Thanks for the thanks. I'm glad to have helped.---
32 months ago
Thanks again for the information.  As a final question, given my exposure, the fact that I tested negative for chlamadia and ghonorhea (I was off an antibiotic for about 5 days, could this have given me a false positive in any way?), and my extremely low chance of siphilus (though I am getting tested at 6 weeks),is there anything else to be concerned about even the slightest amount (want to try and avoid any concerns for my current partner).  I am slightly worried about NGU, but recent posts I read are leading me to believe t is of no concern to her (let’s assume I did have it).  Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
It is conceivable that you acquired gonorrhea and it had been cured by ciprofloxacin before you were tested. It's very unlikely, given no symptoms; and after only 5 days, the test usually would still be positive. For sure the ciprofloxacin would not have given a false negative chlamydia test, and it would have no effect on syphilis testing either.

The only causes of NGU known to cause health problems in men's female partners are chlamydia, which for sure you didn't have, and Mycoplasma genitalium, which is not carried in the mouth or throat and therefore not transmitted mouth to penis. We don't know for sure that NGU from oral sex is harmless for female partners, but there are no reported cases of serious outcomes in such women. In any case, absence of symptoms (discharge, painful urination) is good evidence you didn't catch NGU anyway. While I cannot give you 100% assurance of no potential risk for your partner, there is very little chance of it. If somehow I were in your situation, I would be continuing to have sex with my wife without any concern of infecting or harming her.

That concludes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
 
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