Uncircumcised male here from Malaysia. 

Made a mistake outside my marriage, had an exposure on 12th April - received unprotected oral sex from an female i met online, fingering was involved(bagin

5 days after had discomfort, went to normal GP and was prescribed doxy for 5 days(twice a day). 

Tested for Urine PCR STD (chlam,gono etc) on 14th day(7 days post doxy), 21st day(14days) post doxy and 28th day(21days post doxy). All came back negative. 

However had pelvic, lower abdominal and testicular pain, went to see urologist on 28th day, he ran prostate, ultrasound tests all were normal, however diagnosed me with CPPS, i am now under medication with levofloxacin and cataflam.

My worry now is for syphilis, i did TPHA/VDRL(RPR) test on 4th week(28 days) and 6th week(43 days) post exposure and all were negative.

However on 54th day i noticed rashes on left and right feet. 4 red dots on left and 3 on the right. Prior to that i resumed back jogging after 2 weeks of inactivity due to stress and pelvic pain, and i wore old used socks. So unsure if its due to the socks(fungal) or mosquito bite. The rash is still there as im writing this. But no rashes on the bottom of feet(sole) nor other part of bodies. Noticing this i went to medical lab immediately and did VDRL and Rapid Alere TP Syphilis test and both were negative.

Today when i checked my penis, when i pull the foreskin noticed small red patch skin on bottom of my foreskin, as i am not circumsized this is visible only when i pull it down. 

My questions are,

1) Is my Syphilis test conducted on 6th week and 54th day(8 weeks) conclusive despite the rash or the red spot.  Can i trust my result? 

2) I was taking levafloxacin while doing the syphilis test. Is this accurate? Can i rule out syphilis? 

3) Can i have unprotected sex with my wife?

4) Also is my urine PCR test conclusive?

5) Am i free of STD, i have done additional test for HIV(4th gen at 6th week) and it was negative too.

Please help me out doctor on my dilemma. 

Your situation has been mishandled. It seems your GP is not highly knowledgeable about STDs and their managment. It also appears that you are overreacting a bit: your symptoms reallly do not suggest any STD at all, and certainly not syphilis. Most important, nobody should ever be treated for possible STDs without first testing for them; and should not use antibiotics that will modify the ability of future testing in diagnosing the problem. And "discomfort" alone, espeically without visible discharge from the penis and without genital lesions or sores, usually is not a symptom of STD. This depends somewhat on the details, i.e. the nature of the "discomfort":  feel free to provide more information about it.

To your questions:

1. Even if you had been exposed to syphilis, the doxycycline treatment a few days later probably would have prevented the infection from ever taking hold. (For treating established syphilis, doxy is given for 2 weeks. But 5 days probably is sufficient to prevent infection after exposure.) Almost certainly you do not now have syphilis. In any case, the most recent syphilis blood test proves you are not infected and that syphilis is not a possible cause of your rash or any other synptoms.

2. Unlike doxycycline, levofloxacin has no effect at all on syphilis. That treatment makes no difference in regard to syphilis.

3,5. You do not have syphilis and probably no STD either -- and probably never did. You can safely have sex with your wife without putting her at any health risk.

4. Your urine PCR tests are conclusive in showing you did not have gonorrhea or chlamydia at the time you were tested. However, this is why it was bad practice to treat you with doxycycline without testing you first:  it would have eradicated chlamydia for sure and also most cases of gonorrhea. At this point, there is no way to ever know if you might have acquired gonorrhea or chlamydia that was then cured by doxy. The levofloxacin also would have cued chlamydia and most gonorrhea infections.

Finally, I'm glad you apparently are now in the care of a physician who is quite knowledgeable. But don't expect too much from the treatment s/he has prescribed. CPPS is not an infection, as far as we know. Antibiotics like levofloxacin often are tried in case there is infection the prostate, but usually there is not.

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

HHH, MD

To reasaure, whatever skin lesion(as i assume) like looking that i see when i pull my foreskin is  not related to syphilis since my blood test is negative. Is this right doctor?

And i should not be worried since my blood test at 6th and 8th week are conclusive?

Should i retest at 12 weeks, as mostly people are saying that syphilis is conclusive at 12 weeks? 

Or can i just put this syphilis episode at rest and trust my result at 6th n 8th week is conclusive?

Do i need to look out for further sympoms in regard on syphilis or just ignore it?

Thank you.

There is no point in further syphilis testing. Given the antibiotic treatment you had, it isn't possible -- and confirmed by the negative test results so far. If somehow I were in your situation, I definitely would not have any further syphilis tests. You can also be confident that no symptoms now or in the future are caused by syphilis, assuming no new exposures that could transmit it.

Out of anxiety I went and did another round of test VDRL(RPR) & TPHA(TPPA) at medical lab yesterday. 

And as you said the results came back negative. 

I think it is high time for me to believe in my results that it is conclusive and move forward. 

I am glad that this whole syphilis episode is over/concluded with my 8th weeks results. 

Thank you again doctor for the response and assurance you have given me.