[Question #4911] Syphilis Risk
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78 months ago
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Hello and thank you for providing this very useful forum.
I'm a gay male. On 5 January I received unprotected oral sex from a man I met online. This is the only time I've had any sexual contact with anyone since my last routine tests 6 months ago (which were all negative).
On 25 January I noticed a small round red bump on my penis (about 3mm wide). I went to a local sexual health clinic on 29 January and the doctor examined the bump. She said: it's not a chancre; it doesn't look like a typical syphilis lesion but she couldn't rule it out; my lymph nodes weren't swollen; she didn't recommend treatment at this stage. She took a blood test and arranged for me to take another test at the 6 week mark.
That was kind of reassuring, but I'm still pretty anxious because of the timing. So my questions are:
1. How reliable will my test result at 3.5 weeks be?
2. If my bump goes away and my 6 week test is negative, would I need any further testing?
3. I've been reading up on syphilis and it has some pretty scary symptoms, e.g. hearing loss, vision loss. If the tests show I do have syphilis and I get treatment in the next few weeks, how likely am I to avoid these more serious symptoms?
4. I understand that the HIV risk from receiving oral sex is almost zero. If the other guy were HIV positive, would the presence of a syphilis lesion in his mouth change my HIV risk at all?
5. How effective is treatment with the penicillin injection?
I'm hoping this is just a badly timed pimple, but I'm feeling pretty worried. Thank you for your assistance.
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H. Hunter Handsfield, MD
78 months ago
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Welcome to the forum. Thanks for your question. I happened to log in right after you posted it. Most users should not expect nearly real time replies!
From your description, I agree it is very unlikely the "red bump" was syphilis. Based on your description plus the sexual health clinic provider's assessment, I also would not have treated you. In addition, although oral sex can transmit syphilis, it's not common; most syphilis transmissions between men occur by anal sex. To your specific questions:
1. The anticipated negative blood test result will very reliable. ~90% of new infections would give positive result at 3+ weeks.
2. A negative result at 6 weeks will be conclusive. No need for further testing.
3. Yes, syphilis can be scary. As a man having sex with other men, you are right to be concerned. However, the bad outcomes you mention (and others) do not occur earlier than 3 months after infection, and usually longer than that. Even if this turns out to be syphilis and you are treated for it (e.g. at 6 weeks, if that test is positive), you will be completely protected from such severe consequences.
4. No, even if this is syphilis -- and I stress again it almost certainly is not -- it would not imply any significant risk of HIV from an oral sex exposure.
5. Penicillin in the recommended doses is 100% effective in early infection. There are rare treatment failures, but only in longstanding infection (years), or for certain complications (e.g. neurosyphilis, i.e. central nervous system infection).
I hope these comments ease your worries. Follow-up with testing and with the sexual health clinic -- but if you follow their advice, nothing bad will happen.
Best wishes-- HHH, MD
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78 months ago
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Thank you Dr Handsfield for your very clear and reassuring reply. It's certainly my lucky day to receive a response so quickly! I will follow the clinic's advice and I'll let you know the outcome of my test. Thanks again
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78 months ago
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Hi Dr Handsfield, just following up to let you know that my 3.5 and 6 week tests for syphilis were both negative and the bump went away, so it was a false alarm. They didn't do a 6 week test for HIV but my understanding is that this is essentially no risk for the insertive partner in oral sex. Is further testing for HIV warranted? I had a sore throat on its own about a week after the incident, could that be an ARS symptom? I'm guessing not but thought i'd double check with you. Thanks for your help.
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H. Hunter Handsfield, MD
78 months ago
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Glad to hear about the syphilis test result, but of course not surprised.
You're right about essentially no risk for HIV in this situation, so testing isn't necessary. But up to you: if you find yourself continuing to worry about it, and if a test result will be more reassuring than my words, feel free to do it.
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77 months ago
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Thanks again Dr Handsfield. I think I’ll get a test just for reassurance but I understand it’s essentially zero risk.
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H. Hunter Handsfield, MD
77 months ago
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Thanks for the thanks. I'm glad to hae helped.---