[Question #7578] Possible syphilis?

2 months ago
Hi Doctor,

I am male. Mid Nov I had protected receptive anal and unprotected oral sex. The man was tested and neg for everything 2 months prior.

5 days following encounter - suspected strep throat. Treated with amoxicillin 500/3x daily for 10 days

2 weeks - STD test. All negative

17 days - developed a blister like sore on bottom lip. Not quite on lip but from the lip line down on the skin right below. Blister popped a day later oozing yellowish fluid and scabbed over. Would fill up again with fluid and painful but the scab would easily wash off and became painless until scabbed over again. This happened for 2 days. Then just scab. Totally painless. Indurated.

23 days - treated with penicillin shots in case it was syphilis as I was completely freaking out. Over 5 days the scab flaked off on the edges and completely healed BUT over the next week the induration returned. No scab, just indurated skin like a small scar. But soft and totally painless. 

4 weeks - tested for syphilis and HIV again. Negative. 

5 weeks - developed white patches on tonsils and pain when swallowing. Took penicillin 350/3x daily for 10 days. Cleared up but very slowly. In the meantime the induration began to become less noticeable. Also developed pain and swelling in my armpits and around collar bones and groin. 

6 weeks - full STD test again. All neg. Mono neg, all additional blood tests normal. Dr said lymph nodes are not swollen but the skin in those areas seems to be swollen to me. I still have a red throat and occasionally scratchy feeling.

Going for another full STD and blood checkup at 8 weeks (this weekend) and hopefully put all this behind me. 
Does this sound like syphilis? All the tests have come back negative and my Dr is telling me to believe that but I keep thinking that the treatment failed and the tests are not turning positive because of the antibiotics. Is that a possibility? I live in Canada and we use 4th gen HIV tests and syphilis screen is EIA. Any help would be greatly appreciated.
2 months ago
Hi Doctors,
Just wondering when I can expect a response. The status of my question says there was an update but I don't see a response. 
Sorry if this question is out of line. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
I apologize.  Something was awry with our software yesterday.  I replied but apparently the reply did not “take” and get to you.  FYI, other replies were messed up as well.

The bottom line, before I go into further detail is that you do not have Syphilis and that there is no evidence that you had Syphilis.  There is no medical or scientific reason for further testing related to the encounter you describe above.  Here are the reasons I say this:

1.  The encounter.  While Syphilis is somewhat more common among men who have other males as sex partners, it remains relatively rare.  Thus it is statistically unlikely your partner had Syphilis and even if he did, your condom use protected against Syphilis during your rectal sex.  Syphilis from oral sex is extraordinarily rare.
2.  Antibiotics.  Since the encounter you have had three courses of penicillin like drugs each of which would have cured/prevented Syphilis if you had it.  The bacteria that causes Syphilis is very sensitive to penicillin.
3.  Your tests.  Tests for Syphilis are very reliable for diagnosis.  You have been tested on multiple occasions at times when your results are reliable.  These tests have been consistently negative and should be believed.
4.  Your symptoms.  Neither the lesion you describe nor your sore throat suggests Syphilis.  The sore below your lip may have be impetigo, a common, non-STI streptococcal skin infection.  Sore throat is not typical of Syphilis.

Considering all this, I am confident that you did not get Syphilis.  I see no medical or acid reason for continuing concern or for further testing related to the encounter you describe.  

Again I apologize for the trouble in getting this response to you.  I hope it is helpful. EWH