[Question #8372] Syphilis Testing Timelines

45 months ago

A question about exposure and timing. I had brief (90 secs) unprotected receptive oral sex with a CSW (Asian massage place $120) on Sept 3. This was a mistake I regret, as I always insist on a condom but failed to do so this time. At approximately the six week mark (Oct 13) I did a standard panel test that checked for HIV, HSV, Chlamydia, Gonorrhea and Syphilis. All were negative/non-reactive per Quest Diagnostics.

My questions:

1) How reliable is the syphilis RPR blood test I received at this date -- 40 days past exposure? I see reference to the 4 week to 6 week mark being conclusive?

2) I’ve also read that chancres usually show up by 21 days, and blood testing would usually turn positive around that time or in the few weeks after (i.e. by six weeks). Does the absence of the appearance of a chancre during this period extend the 4-6 week conclusion?

3) I have an area on the underside of the penis, just below the head, that I’ve been hyper-attentive to, in the last few weeks. It does not present like any classic chancre I’ve seen online, and seems to be more of an area of skin tears/abrasion that my memory tells me I’ve had for a while, certainly prior to this incident. There’s no firm border/redness and nothing appears to be inside of the skin break except an under layer of skin, and the appearance hasn’t changed since prior to my first test. Given my results from six weeks, should I be suspicious of this area and get another test? If so, when?

I’m ready to put this behind me, and appreciate your time and response.

45 months ago

I should also add the massage therapist was an asian female approximately 40 years old.

H. Hunter Handsfield, MD

45 months ago

Welcome to the forum. Thanks for your confidence in our services.

This was an exceedingly low risk event: there was little chance for any STI. The chance any particular massage worker has active syphilis is very low; and if infected, transmission by oral sex is uncommon. In addition, your negative test results are conclusive. To your specific questions:

1) Absence of symptoms (chancre, the sore caused by initial syphilis) is itself strong evidence you didn't catch syphilis. The test itself is conclusive at 6 weeks (and 40 days is close enough).

2) True, chancres generally appear within 21 days. But this has no influence on reliability of the blood test.

3) It sounds like nothing is wrong, you're just examining yourself too closely. You needn't be at all suspicious of this area.

I see no reason for concern and no need for additional testing. But see a doctor if you remain concerned about your penile skin.

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

HHH, MD

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45 months ago

Many thanks Doctor. I know you field a large number of these low risk syphilis exposure questions from the overly anxious, and I do count myself as part of that group.

I do find your answer to number two most illuminating, as I probably read every syphilis specific question in this forum twice looking for that answer. As you've said many times -- "the internet is not your friend" for portions of STI research and I never could quite reconcile how such an infection could enter your body and hang out asymptomatically for up to 90 days without triggering a positive blood test by some date threshold, and it sounds like six weeks is the metric that one should be highly confident in.

Based on your answers, I'm moving on and won't be wasting any more time and money with further testing.

H. Hunter Handsfield, MD

45 months ago

Thanks for your understanding and your thanks; I'm glad to have helped. Best wishes.---

45 months ago

Dr, if you will permit me one more question related to this incident. Within the month following, my partner was complaining of yeast infection like symptoms (mostly external itching and very very slight yeast visible on the labia minora). She took the monistat 7 over the counter and all cleared up in a couple days. It was notable because she could not remember the last time she had ever had a yeast infection (she is late 40s).

I never experienced any NGU like symptoms and I never have unprotected exposures outside this event so I wouldn't think it would be any STD like bacteria that doesn't typically like in the oral cavity (Trich/Mycoplasma/etc) . But:

1) is it possible some garden variety bacteria I obtained from this experience is responsible for this yeast infection?

2) We haven't had unprotected relations since and I'm somewhat concerned about resuming. Would it be possible that I could cause a recurrence if I still had that bacteria, or after 2+ months would my/her immune system already taken care of that?

3) I should note that I did take a 10 day course of Ciproflaxin for a prostrate infection (telemedicine prescription) last month. All is well now.

4) I should also note that we had recently begun experimenting with insertive sex toys (vaginally only) and I may not have been very hygienic about cleaning after each use. In fact, I can remember using my saliva at least once for lube purposes.

Thank you for your time.

H. Hunter Handsfield, MD

45 months ago

The combination of your partner's typical symptoms plus resolution on miconazole (Monistat) add up to near certainty she had a vaginal yeast infection. I'm sure it had nothing to do with the low risk sexual event you have described.

1) No. Yeasts are yeasts (separate and different from bacteria) -- that is, no bacteria can cause a yeast infection.

2) I see no reason for you not to be continuing sex with your regular partner.

3) Sorry you didn't include this information originally. Depending on the symptoms and other evidence of prostatitis, and its timing in regard to the oral sex event, I would wonder if the diagnosis of prostatitis was accurate -- especially since you were not directly examined. But in any case this didn't contribute to your partner's yeast infection. However, NGU from oral sex is believed to often result from normal oral bacteria, and probably doesn't create any disease risk in other sex partners.

4) Your sex toy use doesn't sound risky for any infection, yeast or otherwise.

That concludes this thread. I hope the discussion has been helpful.

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