[Question #5728] Syphilis question

19 months ago

I am male in a developed Asian city. I had 3 times protected vaginal/oral sex with sex workers 8 yrs ago. I had a negative HIV test. I have not tested for HIV since and never tested for other STDs.

I now regularly have massages with handjob/body slide with non-penetrative genital grinding. In past few months, I had 3 more times protected vaginal/oral sex with sex workers.

I learned of syphilis and it can stay dormant for 20 yrs and at third stage it can be fatal. I’m worried, since I’ve never tested for STDs other than HIV, and sometime this yr I had a bump underneath my pubic hair in my groin area slightly above the base of my penis shaft (but not on the penis shaft). It seemed firm, probably not an open sore (but I’m not sure what “open” means). I dismissed it, but now worried it could have been a chancre. I don’t know when it appeared/disappeared, so can’t confirm if it was after 1 of the 3 recent events of protected sex.

I had no symptoms of secondary syphilis, but I have a new girlfriend with whom I have protected sex, and she complained of itchy rashes which she thinks was dry skin.

1) What is my risk of syphilis and other STDs? Do I need testing?

2) Can syphilis get to the tertiary stage if it never got to the secondary stage?

3) Is syphilis only contagious when there is a chancre or rash present?

4) I may soon take tests for treponemal antibody by EIA and also HIV Ag/Ab Combo. But I have a cold/flu right now, is it possible that will cause false positives in these tests?

H. Hunter Handsfield, MD

19 months ago

Welcome. Thanks for your question.

Massage is risk free for all STDs. Your skin bump doesn't sound suspicious for syphils or other STDs. "Open sore" means no skin, like a skinned knee that hasn't healed. If there is intact skin over the bump, it's not "open".

1) From all you say, the chance you have syphilis is very low. However, since you're worried and potentiallly have been at risk, you should have a syphils blood test. I expect it to be negative.

2) Not all syphilis causes overt secondary syphilis with symptoms. I very much doubt you have tertiary syphils, which is exceedingly rare these days. When your blood test is negative, you can stop worrying about syphilis of anystage.

3) Syphilis is contagious primarily when there are open lesions, but some level of transmission risk is present for all infections less than a year in duration. After that, it is not transmissible to partners, even with acrtive (e.g. tertiarry) infection.

4) You can be tested at any time. Your cold or influenza will have no effect on reliability of tests for either syphilis or HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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19 months ago

Thanks Dr. Hansdfield for your helpful response and continuing to provide such an invaluable service (you helped allay my fears 8 years ago). I do plan to get tested. I would just like to clarify a few things:

1) For question 2, what I meant was, is it possible for syphilis to skip stage 2 and go directly to stage 3 after years of having the disease? Or will it only eventually get to stage 3 if there were stage 2 symptoms at some point? As you mentioned, some people never get stage 2 symptoms.

2) Do my girlfriend's symptoms sound like syphilis? I understand that the rash should not be itchy.

3) The reason I asked about false positives is because I read that the flu vaccine could cause false positives in HIV tests. I assume the same antibodies are produced when having the flu, so is this not a concern for either the HIV or syphilis tests I mentioned (treponemal antibody by EIA and also HIV Ag/Ab Combo)?

4) You mentioned that tertiary syphilis is exceedingly rare these days - is this the case even for untreated syphilis? I read that about 30-40% of untreated syphilis patients progress to the third stage.

Thanks again for your comments.

H. Hunter Handsfield, MD

19 months ago

1) Yes, tertiary syphilis can occur after secondary is "skipped" in terms of symptoms. Such a person would have positive results on any and all syphilis blood tests. Tertiary syphilis is not transmissible to other persons, by sex or anything else. Transmissibility of syphilis ends a year after acquistion.

2) "Itchy rash" and "dry skin" do not suggest syphilis.

3) The reports you cite are wrong. While in theory certain medical conditions or drugs could alter HIV test reliability, I stress "in theory": There are NO proved cases in which it ever happened.

4) It remains far rarer than that these days, and when tertirary occurs it's generally 10-30 years into the infeciton. One reason it is rare is that most people get antibiotics for various conditions over the years, often curing undiagnosed syphilis.

In any case, you are wasting your time and emotional energy by worrying about this, searching the web, and even asking questions on this forum. Just get tested. When you get the negative result, stop worrying. I will have no further comments at all unless/until you get tested and tell me the result. Please do it within a week, at which time I will close this thread.

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18 months ago

Just following up to let you know that the test for syphilis came back negative. Thanks again for your advice.

H. Hunter Handsfield, MD

18 months ago

Glad to hear it. Thanks for the thanks.---