[Question #446] How Does Syphillis transmit

33 months ago
Hi Dr. 

I had a question on Syphillis transmission. My potential exposure was unprotected oral from a topless dancer in Southern California. I went to my doctor 4 weeks after the event and she gave me a full check up, physically and with blood work. All tests including syphillis came back negative. 

What worries me so much is at about week 3 before I seen her, I was having issues with my butt, I had hemmoroids and they were itching and I think I may have over cleaned and wiped them. I developed an anal fissure as well. I have never had an anal fissure. At week 4 my doctor examined me and also looked at my butt. Being that I was there for an std checkup is it possible she mistaked an anal fissure for a syphillis chancre? Is it possible that saliva from the dancers mouth or fluids leaked to my bottom as I was sitting down? Could syphillis be spread this way? Again I have hemmoroids so I am thinking her saliva could have got on them and that was the point of infection. At 12 weeks I got another rash on my butt. I went back to my doc to test for syphillis, she said the rash would be on my hands and looked at them and said don't worry but didn't test me. I've had the itchy rash for over 1 week now.





Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago

Welcome to the Forum.  I'll be pleased to comment.  Syphilis is transmitted through DIRECT contact with infected lesions (sores), usually in the context of friction creating activity as well (like sex).  There is no evidence that syphilis is transmitted in saliva, particularly saliva that may have contaminated your bottom during receipt of oral sex.  I would also add that syphilis is a relatively rare disease and, at least here in the North America and Western Europe, about 2/3 of syphilis occurs in men who have sex with other men, making your chances of exposure from a commercial sex worker/exotic dancer lower still.

Having said this, I should also acknowledge that syphilis has been referred to as "the great imitator" and both syphilis sores and rashes can be quite variable in appearance.  The rash of syphilis, while classically occurring on the hands and soles of the feet can appear anywhere. 

My guess however is that your rectal discomfort is due to your hemorrhoids and your rash has some other, unrelated cause.  Had the problems you describe been due to syphilis, your syphilis blood test taken 4 weeks after exposure would most likely have been positive.  I agree that there is little medical reason for a repeat syphilis blood test.  Should you decide to seek another test for your peace of mind, I urge you to believe the negative result that I am confident you will get. 

I hope my comments are helpful to you.  Take care.  EWH

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33 months ago
Dr. Hook, 

Thank you for your reply. At this point I am unsure if I should get the test or not. In your opinion after receiving oral sex is it unlikely or impossible that the primary chancre would have appeared on the anus? Is that 1/100 odds or 1 in a million? 

Also, since it is the great imitator would the rash on the butt at 12 weeks be only on that spot only or others as well? The rash on my butt seems to be irritated by stools or by the toilet paper.  I don't have any other rashes on my body but I have had headaches for about a month. 

I read on medhelp Dr. Hands field saying the chancre is exclusively at the point of infection, if my anus was never touched by me or her it seems that it would be next to impossible that the first sore would be there. I seen a photo online of a chancre on an anus and it looked a lot like the fissure the Dr. Diagnosed me with. Do they look a lot alike? 

Thanks for the extra clarification! 

Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago

From the description of the exposure you provide, I am very comfortable in telling you that there is no need for syphilis testing UNLESS you are nervous about it and a negative test result would give you peace of mind.  If that is the case- the test will be negative and you can then move on.  Having said this however, if I were you, I would not waste time with testing.

As I mentioned, direct contact is needed for syphilis transmission to occur- you did not have direct contact with your anus but indirect contact.  As I also told you, syphilis in NOT transmitted in saliva. 

I hope this is clear, if not, please ask again.  EWH

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33 months ago
Dr. Hook,
I took the syphillis test. It was an RPR test. It's been 16 weeks. It came back non reactive.
This is my testing history for the oral exposure, all have been negative.

Week 4
Syphillis blood
Hepatitis (A & B or b, c) blood
Gon/chlamidia urine 
HIV duo blood

Week 7
HIV duo blood

Week 11
HIV  Oraquick Saliva

Week 12 
HIV Oraquick Saliva 

Week 13 (93 days)
HIV duo blood 

Week 16 
Syphillis RPR blood 

Would you say based on this I am in the clear and can put this behind me? Are all results conclusive? I've had headaches lately but have been stressed. My rash on my butt has went away but seems to irritate when I run and that never happened before. If you think I may need any type of other test please advise. If not I am so ready to move on and get some good nights rest. 













Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago

Our Forum provides for up to three responses per question- this will be your 4th and final response. This thread will be closed later today.  If there are more questions you will need to start a new question.  the test results you list above are all conclusive with the exception of your hepatitis results which are a bit early.  I would not worry further about hepatitis however since this infection is not known to be transmitted by oral sex. 

My advice is to accept these results as conclusive.  There is no need for further testing or continuing concern.  Time for you to move forward without concern.  EWH

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