[Question #5970] Syphilis Scare

20 months ago
 I am from Canada and about 7 weeks ago I very stupidly had unprotected oral and vaginal intercourse with a woman that I had known from years ago and now I am freaking out. She told me that she had blood testes done last year and that everything with her is fine but she did not tell me exactly which blood tests she had done.  At 2 weeks and 2 days after the exposure I noticed a round red painless and non-itchy spot on the coronal ridge of my penis and got extremely nervous. Close to 3 weeks post exposure it looked like some dry skin like a scab formed on it and I peeled it off. It was and is still a red round spot. It is still there and is not indurated or open looking. No pus or anything oozing out of it either. I still have it and it has not changed much at all. 2 weeks after the spot appeared I went to my GP to have it checked. He told me that to him it did not look like an STI to him and that it just looks like some red irritated skin. When I asked specifically about syphilis he said ''Syphilis does not look like that''.  Then I contacted the local sexual health clinic here and was seen by a Nurse Practioner at 4 weeks and 6 days post exposure. I showed her the red spot and she was not exactly sure what it is. She said that it does not look like a typical syphilis lesion and when I asked her specifically about if it looked like syphilis she said ''I don't think so but we can test for it.'' I had my first VDRL done at 4 weeks and 6 days and the results were negative. At 6 weeks and two days post exposure I noticed a red spot on my inner right thigh that looks like a hickey but it is definitely not a hickey. It does not hurt much and is not itchy. I tested again at 6 weeks and 4 days and the results are negative. The red spot on my thigh looks like it is fading and the outer part of it looks brownish yellow. I plan to test again at 90 days. 

My question is; 

Are my negative Syphilis VDRL tests at 4 weeks and 6 days and 6 weeks and 4 days good reliable evidence that the symptoms that I have mentioned are likely not from syphilis?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome to the forum. Thanks for your question.

Your question devotes a lot of energy to details of your exposure, symptoms, and previous doctor opinoins. But the most importatn infection is at the end. The VDRL and other syphilis blood tests are highly reliable and detect any and all syphilis, usually by 4 weeks and always by 6 weeks after catching it. So those results prove you don't have syphilis and can stop worrying about it.

In addition, I will add that your exposure was low risk, since heterosexually transmitted syphilis is so rare in Canada (and the US), except in selected high risk populations (inner city African Americans in the US, for example); and that the skin problems and other symptoms you describe don't sound at all like syphilis. It's good you were tested to be certain, but you can now put the idea to rest and continue to work with your doctor(s) about other causes and potential treatment for the symptoms.

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

HHH, MD
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20 months ago
Thank you very much Dr. This really does help.

Now I do have another question that will probably sound very strange. My mind is just going crazy about this. 

Say an individual is infected with syphilis and comes into contact with another individual that is also infected with syphilis. Could that person then get another dose of syphilis on top of what they already have if they are already infected? Also would that screw up test results if that happened?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
If someone with newly acquired but untreated syphilis were exposed again to syphilis, they probably could acquire a second infction on top of the first. But what difference would it make? I don't see that this matters in regard to diagnosis or treatment. The only important aspect, it seems to me, is that blood testing is conclusive only 6 weeks or more after the last possible exposure. I see no reason that this situation would alter blood test reliability, however.---
20 months ago
Okay thank you Dr...Now my last questions.

1.) How long does syphilis remain infectious in semen once it is outside the body?

2.) How likely is it to get syphilis from pecking type kissing if a chancre/lesion is present?

3.) How long can syphilis remain infectious for on household objects such as bedsheets or towels?

4.) Can a secondary syphilis rash be infectious is it is not open or oozing any fluids?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
1,3) Syphilis is never transmitted by contact with semen (or any other body fluid) outside the body, only by sex. And semen probably rarely transmits syphilis anyway. How long the organism survives in such settings ins't the right question. However long it is, nobody ever catches it through environmental contamination.

2. If the chancre is on the lip, i.e. partner difectly exposed by social (nonsexual) kssing, there's probably a very miniscule risk, i.e. very low but not zero.

4) Syphilis is rarely if ever transmitted by contact with dry syphilitic lesions, only oepn sores or moist lesions.

That completes the two follow-up comments and replies included with each thread and so ends this discussion. My final thought is that you're apparently quite obsessed with syphilis. Why that particular STD? When it's one of hhe ones of least risk? And although serious, generally easily treated without long term consequences. If you're not immersed in an especially high risk sexual network -- such as sex with other men -- the risk is very close to zero. Getting checked if there are typical symptoms, plus once yearly routine testing, will virtually 100% protect you from serious outcomes. Syphlis really shouldn't be causing as much concern as it apparently does for you.---