[Question #6207] Syphilis?

16 months ago

Doctors: Thank you for taking my question.

 

Like most people here I made a big mistake and I am highly anxious and feeling guilty. I have only been sexually active with one person for years until recently when we had a falling out due to finding about infidelity on her part.

 

I will try to spell this out clearly and apologize for the detail.

 

 

Six weeks ago:

            Received unprotected fellatio from two married homosexual men for a few minutes each.

 

Four weeks ago:

            Performed cunnilingus on woman and had protected vaginal sex

 

 

Three weeks after the initial encounter I tested negative for chlamydia, gonorrhea, trichomoniasis and HIV.

 

I stopped giving any thought, got back together and had sex with my wife after the initial negative test results.

 

Four and a half weeks after initial encounter I started feeling a tingle in the head of my penis, along with some redness around the corona. I had increased the frequency of masturbation quite a bit in the past week or so prior to this, I believe due to my anxiety.

 

After two days of this I went to a doctor and they started me on Sulfameth (800) / Trimeth (160) because they thought the tingling may be due to past prostatitis or a UTI.

 

Five days after the tingling started, I developed a scab that was partially on the bottom of the corona and partially on the shaft, that was about 0.5cm x 0.2cm, it was flush with the skin, had no particular shape, was not open, bleeding or infected. At first I thought maybe a friction burn, as it seemed to match up with hand placement.

 

That’s when I started to worry again. The next day, (day 6 after the tingling and irritation showed up) I went and had a 10 panel std screening. This would be 5.5 weeks from initial encounter. Everything was negative.

 

I saw a walk-in doctor the same day and he had no answers for the small scab I had and gave me doxycycline for it.

 

It has now been just over 6 weeks and the scab has been healing since it showed up almost one week ago.  

 

My only real concern now is syphilis.

 

1)    Does this sound like syphilis?

2)    Could I have infected my wife at three weeks?

3)    Would the medications I have been on started a cure, therefore, if I show negative, could my wife still be infected?

4)    Is an RPR blood test for syphilis fairly accurate at 5.5 weeks, and just one day after the initial scab showed up, or do I need further testing?

 

 

Thank you for your help, Doctors.

 

Anxiously awaiting your professional input.   

Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome to our Forum and thanks for your question and for your detailed description of your exposure, symptoms and tests.  I'll be happy to provide some information.  Bottom line, this is you syphilis.  Your exposures were low risk- syphilis is very, very acquired from receipt of oral sex and when it is, it is manifest by the appearance of a painless sore at the site of exposure.  Soon after the sore is present, blood tests for syphilis are positive and the syphilis test in your 10 test panel would have been positive if you have acquired syphilis. 

I presume that the sore on your penis that you describe has now healed, correct?

You do not mention how long you took the doxycycline for but 14 days of doxycycline would have certainly cured syphilis if it were present.  I am confident however that the sore on your penis was not syphilis based on all that I have said above and would suggest you not worry and I see no need for further testing of any sort.  Thus, in answer to your specific questions:

1)    Does this sound like syphilis?

No

2)    Could I have infected my wife at three weeks.

No

3)    Would the medications I have been on started a cure, therefore, if I show negative, could my wife still be infected?

See above, the trimethoprim/sulfa would not cure syphilis but the doxycycline would

4)    Is an RPR blood test for syphilis fairly accurate at 5.5 weeks, and just one day after the initial scab showed up, or do I need further testing?

Yes, an RPR at 5.5. weeks would certainly provide accurate information.  I see no need for further testing

I hope this information is helpful to you.  EWH



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15 months ago
Thank you for your response, Dr. Hook. 

The scab has gone and there is still a noticeable red spot of almost the same size. I can still feel it as it heals or if it rubs against fabric it is still sensitive. It has been there for only 5 days and looks to be getting much better. As I said no scab anymore, just sore redness. 

Also it seems that I’ve read that there are no symptoms that precipitate a chancre sore? 

I am in my mid 40s and it tends to take me longer to heal than it used to from even a scratch....

The other constant tingling I feel must be some other underlying cause. I am seeing a urologist nurse practitioner on Tuesday to check on that as well.  I have had constant tingling and lower abdominal pain that started around the same time. Feels like bladder and down through the penis. I have had a UA with bacteria, but no a no growth culture. 

Tomorrow will be 6 weeks and 2 days. I just wanted to check to make sure the 5 week 3 day RPR would be accurate enough because I’ve routinely read six weeks. 

Thank you very much for the information you provide on this forum. 

Respectfully 
15 months ago
I’m sorry I omitted the Doxy. I was prescribed a 100mg capsule 2x/day. I have been on it for 5 days and started after the RPR test at 5 weeks 3 days. 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Thanks for the additional information but it does not change my assessment tor advice..  Particularly in the presence of a lesion (which would typically appear about three weeks after exposure) a 5.5 week RPR would be accurate. 

As for the doxycycline, 100 mg twice daily for 14 days would cure syphilis (which I am confident this is not).  EWH

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