[Question #6945] follow up question #6073

63 months ago

good day doctors:

sorry to revert back to this forum, perhaps it is all the virus news of late, but this concern about syphilis from 7 months ago has resurfaced so i wanted a little clarification please?

dr HH mentioned initially that 'oral or saliva contact with intact skin anywhere on the body, including the scrotum (is risk free) ' and then followed with syphilis risk is 'probably exceedingly low' -- i guess i am confused about 'no risk' and then 'exceedingly low' risk?

also, in the event that my scrotum did receive syphilis and i did not somehow notice this, how could it infect my wife through normal sexual relations if she never licked my scrotum?

lastly, i was tested 2-3 weeks after this encounter, i now realize that was too soon -- negative, so i guess i know i did not have it prior to this, which is good. so for this singular event can i dismiss it as zero risk period and move on finally?

H. Hunter Handsfield, MD

63 months ago

Welcome back. I reviewed the discussion we had a few months ago. My assessment and advice are unchanged. The evidence you did not catch syphilis is very strong: 1) It is statistically unlikely your partner had infectious (transmissible) syphilis; 2) if she did, the exposures described carried little or no risk of transmisison; 3) you didn't develop a chancre at the site(s) where she contacted you with either mouth or hands, or otherwise exposed to body fluids. Your negative blood test also is in your favor: at 2-3 weeks somewhere around half of all newly infected people would have positive blood test results, so that result is modestly reassuring although not conclusive in itself. Finally, if you had acquired syphilis, by now you likely would have had symptoms and signs of secondary syphilis, like a body wide skin rash. For you to have syphilis, every one of those unlikely possibilities would have had to break the wrong way. The odds against it are probably in the range of one in several million.

So I stand by my advice last time: you can forget this, and from a strictly medical and risk standpoint, you don't need more testing. However, it seems likely you're going to continue to worry and wonder. Therefore, I suggest another syphilis blood test -- not because I think there is any chance it will be positive, but because the negative result may reassure you more than my advice has done. So it's up to you. If somehow I were in your situation, I would not feel a need for testing (and wouldn't have had the earlier blood test either). If you decide to be tested, stay mellow in the meantime: you can count on a negative result.

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

HHH, MD

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63 months ago

thank you much of that is clear — i guess where i am stuck is if that 'oral or saliva contact with intact skin anywhere on the body, including the scrotum (is risk free) ' how can there be any risk at all, even if 1 in 3 million?

and also my real concern is if i had transmitted something to my wife.

she would have to had some symptoms by now too? which to my knowledge she has not. perhaps that lowers the caclulations further? but still leaves me wondering about the aforementioned question.

i do bruise from blood testing so ideally i’d like to avoid another else i’d have to explain why i had one!

i do trust your expertise i guess i’d rather here not risk at all rather than 1 in 3 million.

but if you kindly can provide some guidance on the questions above i would be most grateful!

thank you.

H. Hunter Handsfield, MD

63 months ago

I don't know where your 1 in 3 million figure comes from. (I used the phrase "one in several million".) But of course nobody can give a 100% guarantee that oral or saliva contact with intact skin carries zero risk of syphilis. But if there's any risk at all, I suppose 1 in 3 million is as good a guess as any, which of course is zero for all practical purposes.

Your other comments don't move the needle one way or the other. Your wife's lack of symptoms doesn't mean anything; even if you have syphilis, without a chancre or rash,you weren't necessarily infectious. As I said, it's up to you whether or not to have a blood test; you czn easily prevent the bruising that might result. But I really think you're overreacting -- perhaps out of guilt or shame over a sexual decision you regret. But your choice.

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63 months ago

thank you, and yes, i think you hit the nail on the head -- regret, no question, and guilt.

however i do have three more academic questions.

i have read that in taking the RPR test sometimes biological false positives occur which are then confirmed or negated automatically. who knows, if i have had covid, or some other flu, and i am creating antibodies, could that false positive occur, and if it does, and the confirmation is negative for syphilis, would i need to repeat the testing process 6m down the road, or at all? that kind of anxiety might not be worth it?

also, in your decades of experience, have you ever seen or heard of or read about someone contracting syphilis in the manner i am explaining -- having someone lick your scrotum?

and lastly, for my own peace of mind, i feel that if someone licked my elbow, neck, ear, or arm, i would not be concerned at all -- but for some reason the scrotum has me wondering. is there any difference in licking intact skin of elbow, neck, ear, or arm vs the scrotum with regard to syphilis risk?

thank you again for the forum and your patience and your advice.

63 months ago

oh yes, i forgot, i have also read about the proposed advent of rapid syphilis testing (similar to alere determine for hiv -- finger prick tests, no blood draw from vein, 15 min results) in places in the USA -- are they available, if so where, and are they reliable?

H. Hunter Handsfield, MD

63 months ago

The frequency of false positive RPR results is low and not known to result from other infections; and such results are easily resolved with confirmatory testing. This concern is never a valid reason to not be tested for syphilis.

No, I've never heard of any patient who acquired syphilis from an exposure such as you describe. Same for licking, anywhere on the body. The skin of the scrotum is no more susceptible to syhphilis (or any STD) than the skin anywhere else on the body.

Last I heard, two point-of-care (15 min) syphilis blood tests (fingerstick) are FDA approved. One trade name is Syphilis Health Check, by Trinity Biotech; I don't know the other. I imagine most major labs and lots of online testing services offer it.

That completes the two follow-up exchanges included with each question and so ends this thread. Please note that repeated questions on the same topic or exposure are strongly discouraged; this being your third on this exposure and your concerns about syphilis, it should be your last. There will be no point in telling us about your upcoming negative result, assuming you follow through with testing. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, our experience is that continued answers to anxiety-driven questions simply prolong those anxieties, when a better option is usually to seek professional counseling. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding. I do hope the discussions have been helpful and reassuring, as intended. Best wishes and stay safe.

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