[Question #4847] Questions about syphilis cont.

27 months ago
Hi Dr.’s, I am sorry to return. I tried to move on like Dr H said I should after my last questions. He was going to leave the thread open so I could post my test results and the antibiotic I was on and asking about before but I noticed a few weeks later that it was closed. I Had some other questions that were bothering me and A few other things I forgot to mention so I am back. I did not end up having the syphilis test because I tried to listen to Dr. H when he said I have nothing to worry about and move on but I am still having symptoms. I still have muscle pains/ aches all over and muscle twitching on a daily basis.  And also white tongue. Daily runny nose and Sometimes loud ringing In my ears and like my hearing goes out for a minute, dizziness and mental fog or confusion. I know he said my symptoms are not from syphilis but I can’t shake it. The antibiotic I was on and mentioned before was clindamycin, would that have affected syphilis and caused a herx? Also I wanted to add a few more things, I feel like my questions were miss read from the start because you thought I was a male but I am a female who received cunnilingis from another female and kissed. Maybe you would have answered them differently if you knew I was a female from the beginning, I’m not sure and would like to know.  The girl is very promiscuous in her 20’s and sleeps around with men and women. She said she had no infections at the time and I had nothing to worry about but I feel like she is an untruthful person and not sure I can believe her. I know you say that oral sex is very low for transmission of syphilis especially among women but 
1. I want to know if her having lots of partners both men and women and possibly other bisexual men or women changes your opinion?
2. I had mentioned that I had a white tongue and what I thought was leukoplakia patches. You said leukoplakia isn’t caused from syphilis so after doing more research I’m thinking the white patches on the side of my tongue could have been mucous patches? Or snail track ulcers? Do these occur often in syphilis?
3. For her to have given me syphilis, is the only way for her to have had a chancre on the tip of her tongue? where it would have rubbed into my vaginal mucosa? Or could she have had mucous patches from syphilis on her tongue and spread to me that way? I do remember her tongue being white also which is why I freaked out when mine turned white shortly after. 
4. Is it easier for syphilis to pass to females genitals from a tongue compared to men because of the thin skin in our vagina area? Or same percentage of transmission risk to a penis?

Also looking back I do remember having a red sore inside my urethra opening it was very hard to see because it was right inside the opening  but at the time I was more worried about hiv at that time and didn’t even know about syphilis which is why I didn’t think of it being a chancre and wasn’t tested for syphilis back then. I didn’t notice it until 3 and a half months after the encounter. It could have been there for a few weeks without me knowing but I’m not sure. 
5. I’ve read that you say this is too long for a chancre? I only noticed it for 2 days before it was gone but it may have been there before I noticed. And I caught it when it was healing? It was in a hard to see spot even with a mirror. 
6.What are the stages of a chancre? is it noticeable the whole time or starts small and heals or scabs over? Or does it just disappear?
7. Also my fiancé’s rash on his chest and back was 1 month after the encounter. I know syphilis rash is highly variable but Is it possible for a syphilis rash to last only a day or two? 
8. I never had any typical syphilis rashes that I recall but I did have some contact dermatitis type rashes and I don’t usualy get rashes. Could these have been from syphilis?
9.Also you had said that muscle pains or aches is not a symptom of syphilis. Could you explain this?that is one of my most persistent symptoms. My fiancé also complains of hurting all the time and I’m now really worried. 
10.Does any of this change your mind that I may actually have Contracted syphilis and should really be tested? Or only because of my continued anxiety? 
The only other thing that I have read that matches all my symptoms is Lyme disease. I know it is close with syphilis bacteria  but can the symptoms be exactly the same? I don’t ever recall being bit by a tick and don’t live near woods.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome back to our Forum.  On this occasion I'll be answering your new questions.  In preparing to reply, I did review your earlier interaction with Dr. Handsfield and I agree with all that he said.  I should mention that we typically keep threads open for three replies or for a month following our last reply- I suspect that is why your earlier interaction was closed.  I would also like to start by suggesting that you get a syphilis blood test- they are widely available and inexpensive.  If confidentiality is an issue, health departments typically provide confidential services.  The reason I suggest this, even before answering your questions is because like Dr. Handsfield I feel it is most unlikely that you have syphilis and that a negative blood test will put all of your concerns to rest.  If your symptoms are due to syphilis, a blood test would be positive.  If it negative (and I am confident it would be) you should work with your doctor to look for other causes of your symptoms.  With that, I'll address your specific questions:
1. I want to know if her having lots of partners both men and women and possibly other bisexual men or women changes your opinion?
While having many partners tends to increase risk for all STIs, most people with lots of partners do not have STIs. when they do, it is rarely syphilis.  In 2017 there were fewer than 28,000 cases of infectious syphilis among our population of over 300,000,000 and only 10% of syphilis occurred in women.

2. I had mentioned that I had a white tongue and what I thought was leukoplakia patches. You said leukoplakia isn’t caused from syphilis so after doing more research I’m thinking the white patches on the side of my tongue could have been mucous patches? Or snail track ulcers? Do these occur often in syphilis?
The manifestations of syphilis are quite variable.  Among them, mucous patches are a rare manifestation of syphilis.  Rather than try to guess, the blood test I suggested would settle this

3. For her to have given me syphilis, is the only way for her to have had a chancre on the tip of her tongue? where it would have rubbed into my vaginal mucosa? Or could she have had mucous patches from syphilis on her tongue and spread to me that way? I do remember her tongue being white also which is why I freaked out when mine turned white shortly after. 
Contact with either a mucous patch or a chancre could transmit syphilis if she had syphilis.  It is unlikely she had syphilis, as we've pointed out and if she did, it would be unusual for her to have either a chancre on her tongue of a mucous patch.

4. Is it easier for syphilis to pass to females genitals from a tongue compared to men because of the thin skin in our vagina area? Or same percentage of transmission risk to a penis?
There are no scientific data available to answer this question.  I would presume that the efficiency of transmission is about the same for each gender.

5. I’ve read that you say this is too long for a chancre? I only noticed it for 2 days before it was gone but it may have been there before I noticed. And I caught it when it was healing? It was in a hard to see spot even with a mirror. 
No good answer for this statement. it is a "what if" question which cannot be answered easily.  Get he blood test.

6.What are the stages of a chancre? is it noticeable the whole time or starts small and heals or scabs over? Or does it just disappear?
Chancres appear as a bump on the skin which quickly, over a day or two, become open sores with a clean (non-blood base). they heal over a period of several weeks.

7. Also my fiancé’s rash on his chest and back was 1 month after the encounter. I know syphilis rash is highly variable but Is it possible for a syphilis rash to last only a day or two? 
This would be VERY unusual.

8. I never had any typical syphilis rashes that I recall but I did have some contact dermatitis type rashes and I don’t usualy get rashes. Could these have been from syphilis?
As Dr. Handsfield told you, the clinical presentations of syphilis are highly variable.  Another "what if" question that you can answer by gettinga blood test.

9.Also you had said that muscle pains or aches is not a symptom of syphilis. Could you explain this?that is one of my most persistent symptoms. My fiancé also complains of hurting all the time and I’m now really worried. 
Not sure how to elaborate. Persons with syphilis typically do not have muscle or joint pains.

10.Does any of this change your mind that I may actually have Contracted syphilis and should really be tested? Or only because of my continued anxiety.
I sincerely doubt that you have syphilis.  You may have some other, systemic illness. My recommendations are to get the syphilis blood test to prove that this is not syphilis, then work with your own doctor to find out what is going on. 

Your questions and post are quite long, beyond what we typically accept.  My further replies will be far briefer.  I hope the information I have provided helps.  EWH


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26 months ago
Hi, Doctors!  thank you for your reply and answering all my questions  Dr. Hook.  Sorry it has taken so long for me to respond. And sorry for the long previous post. Your answers were very helpful. I will try to keep this one much shorter. I have some more questions which I hope you will answer. 
1. I am understanding that I should have nothing to worry about from this exposure and I would have to have the worst possible luck in order to have contracted syphilis from this?
2. chances are very small  that I could have contracted syphilis in this way. And the only way in which I could have is if she had a chancre or mucous patch in her mouth which is highly unlikely? I could not get it from her saliva or blood/ cut in the mouth/tongue?
3. So even if she did have syphilis, it would be very rare for me to have acquired it from cunnilingus? 
4. What would be the percentage of this occurring?
5.if I did acquire it then my fiancé would also have it and it would be unlikely that he would miss the chancre on his penis also? 
6Would clyndamicin have had an affect on syphilis if I were to have had it?
7.I would like to know what you would consider typical manifestations of the symptoms and stages of syphilis since you are the experts, and most of what I have read on the internet seems to have been missinformarion. if you were to explain what typical symptoms and stages would be?
8.You said a chancre has a non blood base, what does that mean? Does it look bloody or blistery? But when you touch it no blood would be present?
9. does syphilis cause skin manifestations other than the rash and chancre? Such as scarring or skin and muscle atrophy/indentions? 
10.Does it cause upset stomach/ chronic diarrhea and ear ringing or pain? 
Thank you again so much for what you all do here. You put a lot of minds at ease. Including mine by answering questions we would be afraid or ashamed to ask face to face in a doctors office. I will be getting tested. I feel more confidant that it will be negative. And I will save my last question/ response to post my results. I am ready to move forward with my life and not worry anymore. Thank you again! 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
No problem with your delayed response- you were back within 30 days which is when open questions are closed administratively.  Straight to your follow-up questions:
1.  Correct.  The odds of you having gotten syphilis from the exposure you reported are about the same as getting struck by lightening.
2.  Correct. No risk from blood of saliva exposure during cunnilingus.  
3.  Correct
4.  This problem is so rare that that there are not good studies to provide a percentage estimate of your risk of syphilis in the unlikely situation that she had a syphilitic lesion in her mouth
5.  Men are more likely to detect a chancre than women because the chancre could occur on the penis.  Men look at their penis more often than women look into their vagina.
6.  There are no studies of the effect of clindamycin on syphilis.  It may have some activity but I would not count on it.
7.  This is a complex question.  The typical lesion of primary syphilis is a chancre at the site of inoculation.  The most common manifestation of the second stage is a rash but there are many, many other manifestations.  As Dr. Handsfield already told you, the best way to prove that you do not have syphilis is with a blood test.
8.  The base of a chancre is typically "clean" and not bloody.  It is an open sore.
9.  Those are the main manifestations.  Rather than worry about "what if" situations, you should just be tested.
10.  these would be unusual manifestations of syphilis

I look forward to hearing your test results.  I am confident it will be negative.  EWH
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25 months ago
Thank you Dr. Hook for all of your help. You and Dr. Handsfield’s confidence in my test being negative has put me at some ease and although I haven’t  tested yet I will be doing so soon. I admit I have been afraid and building up the courage. I have read and re read all of your answers to my questions to help ease my nerves and build my confidence to test. Knowing in my mind that it will be negative will help me to go through with it but I can’t shake the fact that I might be the one in a million chance to acquire syphilis in a rare and uncommon way. I have really terrible luck and because of all of my symptoms I feel as though I may have hit the unlucky jackpot. The reason I am so afraid is my upcoming wedding and I hate to lose the love of my life due to this situation but I realize I have to suck it up and be tested. I will go ahead and use my third and final questions/response since I am nearing the Closing of this tread. When I do test which will be soon, I will purchase a new question and come back only if my result is positive. In which case I’m sure I would have more questions. If it is negative like you say it will be, you will not hear from me again. So I want to sincerely Thank you for all your help and answers in case we hopefully do not speak again. No offense! here are my final questions. I do still continue to worry because most other posts about syphilis being acquired from oral sex you say not to worry because chance is very small and you would not be tested if it were you, my fear is that you may think there is a chance that I could have been because of my symptoms which is why you suggested for me to test?
1. I know that you have said syphilis symptoms are highly variable. So I am having a hard time understanding how none of my multiple symptoms from my previous post and this one suggest syphilis? And none are symptoms of syphilis? I only question this because Of other websites I came across before this one and all mentioned most of my symptoms as syphilis. Which is what led me to fear syphilis in the first place. If you could explain this in its detail please I would appreciate it.
2.also you said a rash is the main manifestation in secondary syphilis and that their are many many more. What are the other main secondary symptoms? This is why I am confused about none of my symptoms being syphilis related.  I feel if this correct information was on the internet instead of the false information I read and worried months over it would save people worry including myself. 
3.  Is one month after exposure too soon for secondary syphilis rash to occur? Can rash appear before a chancre or at the same time?
4. I’ve read in others posts that you can acquire syphilis even if you don’t see a sore does this mean only because you may not have noticed it or you can get syphilis even without a sore present? 
5. I did have petechiae spots on the tops of both of my feet about a year after my exposure. I had never had this before or since. Could that have been a syphilis rash?
6. Why is syphilis so rare in the mouth? And not usually transferred from kissing? Is it harder to penetrate the oral mucosa?
7. Could you acquire syphilis from shaking someone’s hand that has the hand rash? 
8. Also I have noticed a good bit of hair thinning and hair loss. Does syphilis cause hairloss and thinning all over the head or just the big bald patches like the pictures?
9. If you were me would you be worried or is my fear unrealistic over all this?
Thank you again Dr.’s for all of your expert help. I really appreciate you answering all my questions and helping to put my mind at ease. I hope I do not have to come back with positive results as it will mean my soon to be marriage, plans to start a family and life will be over. Thank you again, Take care!
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
thanks for your thanks.  I appreciate your concern but remain confident that when you test you will find that your test is negative and will then be able to move on.  I agree with your risk as being in the range of 1 in a million or les which is less than your risk of being struck by lightening this year (1 in 500,000).  Let's address your final questions:

1.  Symptoms can have many causes and are clues to look for problems.  Certainly, as you have already asked symptoms such as a white tongue or ringing in your ears might sometimes be caused by syphilis but very rarely and typically in combination with other more classical symptoms.  Rather than argue about whether or not something MIGHT have been caused by syphilis, they way to address the problem is to get tested, as I have recommended.  it will resolve the question.
2.  Sigh.  Please read my answer above.  Syphilis can cause most anything.   The than the rash, the most common sign of infection is generalized (not localized or isolated) lymph node swelling.  the infection can also cause wart-like lesions called condylomata lata.
3.  the rash and a chancre can co-exist.  One month is a bit early for secondary manifestations of infection.  Please remember, there are thousand page books listing the causes of different rashes.  To assume that a rash after such a low risk exposure is over reaching.
4.  Most experts believe that a sore is present band when persons do not know about the sore, they have missed it.
5.  No
6.  the nature and duration of exposures make syphilis of mouth rare.  
7.  No, not unless there is an open sore on the hand
8.  The syphilitic involvement of the hair and head is classically patchy.
9.  I think your fears are unwarranted and would be flabbergasted if you turned out to have syphilis.  PLEASE get tested sooner than later so that you can put these fears behind you and move forward with your relationship and your life.

Take care.  I trust that once tested you will not need to return because your test will be negative. EWH
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