[Question #4764] syphilis test performed at 73 days

27 months ago
Dear Drs
I am a 36yr old man.
3 mo. ago I had a misstep considered as "no risk" by our French prevention network: protected BJ+french kiss from an Eastern europa escort here in Paris.

I tested HIV+Syph at days 31 and 60. All NEG. This first ended my fears.

At exact 10 weeks, a 2-3mm translucid 1/2 spheric thing showed on my mouth lower internal lip. This was filled with clear liquid. I squizzed it, it exploded easily and completely healed within 2 days. It had none of the typical characteristics of a chancre. But this woke up my fears.

Went for another syphilis test 3 days after this (10.5w-day73). Negative.

All tests were Roche ECLIA Syphilis blood test (igg/igm).

I am close to find my way out of anxiety and back to my beloved girlfriend. To put a final period on that, would you kindly confirm the following:

1- Is indeed a syphilis sore after 8 weeks unrealistic? In this instance, 10 weeks?

2- Does repetition of syphilis tests at 4.5, 8.5, and 10.5 weeks absolutely rule out syphilis even if my latest test was only 3 days after this "thing" appeared? I read here a thread where Australian clinicians said a patient a 72 day neg test is "rock solid" and you confirmed. My latest test was at 73 days.

3- Some talk about (rare) 3-month incubation. Would a test at 3mo make a difference in the confidence vs. my 10.5 weeks test?  I read 3 month mark is an overly conservative mark used informed you've been in contact with a known syphilis case and thus intended to cover uncertainty in contact date. is that correct?

Many many thanks for time you'll spend answering this post. Kindest regards
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome to the Forum.  I'll be glad to comment and, hopefully, to relieve your concerns.  For Syphilis to be acquired by French kissing is close to unheard of and for an initial Syphilis lesion to appear at 10 weeks is likewise not likely.  Finally the lesion you describe is not in the least bit suggestive of Syphilis, either in terms of appearance or in terms of how quickly it healed.  Thus, in answer to your questions:
1.  See above.  This would be extraordinarily uncommon.
2. Yes, you have proven that you did not get Syphilis from your misstep 
3.  You are correct, the three month guideline is overly conservative, reflecting how imprecise some people's memories are. Your results are conclusive, you are in the clear.

I hope these responses are helpful.  Time to put your misstep M behind you.  EWH
27 months ago
Many many thanks Doctor for this rapid answer.

So, my 73 day test definitely rules out every possibility this strange lesion that appeared 3 days before testing could be linked to syphilis. Had it been, the test would have turned positive, correct? The negative test at 73 days overrules every kind of "symptoms" I would have "noticed" in the 0-73 days period and also can assure me that any future "things" I will notice in my mouth cannot be syphilis related.

This will allow me to definitely turn the page without any remaining doubt and resume enjoying life with my girlfriend. I will avoid such stupid behavior in future.

Whish you and all the team a wonderful and happy new year2019. Mine will start with definitive confidence in my results thanks to your comments.

I am admirative of the work you've done with Dr HHH on this palteform and previously on some other. I referred to them to them to get relevant and trustful information over the past few weeks and thus was more than helpful.

Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Correct. Your day 73 test rules out the possibility that the lesion you noted was syphilis.  Indeed, it also rules out any possibility that any any signs or symptoms you may have noted prior to that time would be due to syphilis as well.  You are in the clear.  

I hope that this assurance will allow you to move forward without continuing concerns.  EWH
27 months ago
Dear Doctor(s), I’d like to thank you for the wonderful service and expertise you make available to stubborn anxious people like me. I was waiting for my 3-month test when I posted. It came back negative. Thanks to you, I was not worrying at all. It definitely helped, A LOT.

I donated the same amount of money I spent in medically unnecessary tests to the French association which nationally informs on STD through hotline. At least THIS would be valuably spent.

I let you decide whether it’s worth reacting to what follows for others to read or to delete if it introduces more confusion to messages you convey. My case is closed anyway.

You recommend reading already available resources instead of repeatedly asking. I did it EXTENSIVELY. I am from scientific education and, to be honest, what puzzles me is how the following correlate (or not):

 1. A syphilis blood test turns positive a few days after appearance of a chancre (5 days with EIA, 7-10 with some others) BUT may be falsely negative in btw.

2. a negative test after max  admitted  seroconversion period (6+ wk) is absolute evidence that no contamination occurred.

Should “lesion” appear immediately before or after a negative test performed by 6+ wk (in my case “lesion” @70 d, neg test @73 d), why the test definitely rules syphilis while a chancre at that time is rare but cannot be excluded?

What I deduced is they are used by clinicians at different moments: first criterion is relevant to know whether a chancre which appeared WITHIN the 0-6+ weeks after risk is syphilitic. Beyond this timeframe with a neg blood test, second criterion PREVAILS, regardless of symptoms PRIOR OR AFTER, because at that time a blood test will have turned positive even if a chancre is to later manifest. Don't know if it is correct, but that the info I have looking for weeks.

Again feel free to delete if not worth and close this thread.
Again all my grateful thanks.
Take care.

Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
thanks for your summary and comments.  I agree with nearly all that you have said.  The one point I would make however is that I have never heard or seen of a primary syphilitic lesion appearing more than 60 days after an exposure.  

Thanks as well for your contribution to the French Association promoting sexual health.  I am sure it will be helpful in promoting knowledge and understanding.  

As you suggest, this will complete this thread which will be closed later today.  Again, thanks for your confidence in our service. EWH