[Question #5231] Syphilis Risk

25 months ago
Hi doctor I recently had a drunken encounter with a stripper in mexico. I received a blowjob from the stripper, however a condom was used but I am still freaked out because the condom was provided by her and she put it on before I was fully erect. After I ejaculated the condom was still on and she put a glove on and removed it from my penis. So then I went and got tested two weeks post exposure for syphillis, gonnorhea, chlamydia, hiv and all were negative. I was told by the tester that the test for syphilis was accurate even though it had only been two weeks and he said I required no further testing. I have not noticed any chancres or anything out of the ordinary on my genitalia. I am just wondering if the test for syphilis at 2 weeks was reliable and if I can move on and forget about this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome to the forum and thanks for your confidence in our services. I happened to log in a few minutes after you posted your question:  most users should not expect nearly real time replies!

The chance of syphilis from this event is very, very low. First, at any point in time, the large majority of female sex workers do not have syphilis. While I do not have specific information on this for Mexico, to my knowledge this statement is just as true as in the US. In North America, the large majority of syphilis currently is in men who have sex with men. Second, oral sex is an inefficient syphilis transmission mechanism. It could happen, but most cases are acquired by vaginal or anal sex. Finally, an intact condom is extremely protective, probably >99% certainty. Syphilis cannot be transmitted through intact latex or polyurethane, and with oral sex, usually there is little if any contact with unprotected skin (unlike vaginal sex).

Urine tests for gonorrhea and syphilis are entirely valid 2 weeks after exposure (and the condom would have protected against these). However, it takes up to 6 weeks for conclusive testing for either syphilis or HIV. In view of the virtually zero risk from this event, I consider both syphilis and HIV testing optional. (Even with no condom, there has never been a proved case of HIV transmission mouth to penis.) However, if you need 100% conclusive test results, get retested 6 weeks after the event. But I truly do not believe testing is necessary. If you have a regular sex partner, you can safely continue your usual sexual practices without risk of transmitting anything.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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24 months ago
I also had a exposure like this while visiting africa last week, is this a high risk area?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Depends on where in Africa and your partner's risks. Could be zero risk to quite high.

Note the forum policy is to answer two follow-up comments/questions and moderator replies before the thread is closed, so you have one coming. Pretty much no matter what you say, for 100% assurance you did not acquire syphilis, you'll need a blood test 6 weeks or more after exposure. However, even if this turns out to be a very high risk situation, almost all syphilis from oral sex would result in an obvious open sore (chancre) at the exposed site, i.e. your penis. If no such sore within 3-4 weeks after exposure, you can be confident you were not infected -- but still should confirm it with a blood test at 6 weeks. Other STDs are higher risk from oral sex, including herpes (due to HSV1), gonorrhea, and nongonococcal urethritis (NGU).
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