[Question #4195] Fellatio with Syphilis Secondary Stage

31 months ago
Im Male from Malaysia. I am HIV positive since year 2016, on medication and undetectable. Unfortunately, I tested positive for Syphilis secondary stage yesterday (28th Sep 2018). I'm panic and paranoid now because I performed unprotected Fellatio on my boyfriend(HIV Negative, No STD) for 20 mins 3 Days ago,I also rimmed him without protection but with condom for anal.  I had rashes when performing fellatio on him because we didn't know it was Syphilis. My question is "Will i transmit the virus to him? how high is the chances i've infected him?" 

For my understanding, there is risk transmitting the virus through oral sex, and for Syphilis it will only transmit when direct contact with cut/ open sores on both party.  (I do not have open chancre/sores in my mouth when I fellatio on him, and he doesn't have cut/open sores on his penis too) 

From what Doctors replies to the similar questions in the MedHelp forum, the answer is zero and close to zero, but its based on the data from US/Europe. 

I love him dearly, and I do not want to infect him because of my stupid mistake. 

Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Welcome to our Forum.  I'll do my best to help.  Let me start by saying that from what you say that your risk of having transmitted y our HIV to him through oral sex is very, very low.  At present , across the world, it is now generally agreed upon that "undetectable=untransmittable".  Meaning that if you are fully suppressed for your HIV infection, you will not transmit your HIV to others.  This is all the more true for oral sex and rimming which are very low risk for HIV transmission compared to other sorts of exposures.

I would also add that I hope that your partner has been treated preventatively with penicillin for his exposure to Syphilis. This is true even in the absence of oral Syphilis lesions for you and is a recommendation that is made out of an abundance of caution.  Again, while the chance of having acquired Syphilis through the routes of exposure you describe, preventative therapy is nonetheless recommended.

I hope these comments are helpful to you.  EWH
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31 months ago
Thank you Doctor Edward for your prompt reply, I am not worry about HIV transmission. I'm actually worry about infecting him with Syphilis as I'm I'm on secondary stage of Syphilis. What I learn from Medhelp forum it is inefficient for Syphilis to transmit through oral sex, and the risk is low.  Hoping doctor can help to ease my anxious and scared by answering the following questions: 

1. I do not have open chancre/sores in my mouth when I fellatio on him, and he doesn't have cut/open sores on his penis too, in this case will I still infect him with Syphilis? If yes, how high is the chances?

2. When my Boyfriend will show symptoms if he is infected? 

3. If he does not show any symptoms, can I take it as he's not infected with Syphilis?

4. Can I still perform Fellation for him during this period of time? or in future ? 

I am sorry you might think that Im very irresponsible for not asking him to get treated now. I am basically in waiting game, if he does not show any symptoms then I will not let him know that I diagnosed with Syphilis. 
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
I apologize for the delayed resonse to your follow-up question.  I was traveling and missed the questions.  Nonethess, I still think it would have been proper to infrom your BF of your infection so he could be treated.  At this time however, a test for syphilis in him will prove whether or not he was infected. 

1. I do not have open chancre/sores in my mouth when I fellatio on him, and he doesn't have cut/open sores on his penis too, in this case will I still infect him with Syphilis? If yes, how high is the chances?
Syphilis is transmitted by direct lesion contact.  If lesions were not present, there is virtually no risk that he was infected.

2. When my Boyfriend will show symptoms if he is infected? 
On average, syphilis lesions (the chancre/sore appear within 21 days of exposure to an infected sex partner if they are going to appear.

3. If he does not show any symptoms, can I take it as he's not infected with Syphilis?
I blood test remains the best way to be sure he was not infected. 

4. Can I still perform Fellation for him during this period of time? or in future ? 
Once you are treated and more than 24-48 hours have passed, you will not be able to transfer infection to him. 
Again, sorry for the delayed response.  EWH

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