Yesterday I met a guy and was invited to come over later on. I always ask beforehand if he has any std’s. He said he is a prep user and hiv negative. Every 3 months he needs to check his blood in order to get prep. We went to the bedroom and he used his saliva as lube on my anus, then we used real lube. Meanwhile we kissed and he gave me unprotected blowjob. For anal sex he used a condom and I’ve put some lube on it so to be extra safe.  Protected anal sex didn’t last more than 5 min and we went on kissing again and I received unprotected oral again. 

Afterwards we talked a bit and I said that I am scared to catch std. I had full check std panel last month and everything came back negative. He showed also his lab results from one month ago, he was negative for hiv, hep c. His result for syphilis: treponema screening antibodies positive, tppa reactive (1:640), rpr negative. He said he probably had in the past infection but didn’t notice much of it and that the clinic is very severe. The clinic wants to stop std among high risk people. I didn’t notice sores , lesions or rash on his penis, body  or in his mouth but of course I didn’t  examine him in full detail. Now I worry that I don’t know for sure if the syphilis is active or a past infection. He said that he is not infectious and the follow up in clinic for std’s is well monitored.

What is my risk here?

Kind regards

His test results are compatible with syphilis which has been treated in the past or longstanding untreated syphilis.   From the sounds of things, it is not clear whether he was sure he'd been treated in the past or not.  this makes providing advice a bit tough.  If he's not sure if he's ever been treated for syphilis, the standard recommendation in this situation (despite the low risk of your exposures) is to be on the safe side, you should receive preventative treatment for syphilis as a recent "contact" to a partner with possible syphilis.  OTOH, if he is confident that he has been treated for syphilis in the past, then there is no need for preventative therapy.  From the sounds of things, his PrEP clinic is pretty strict about testing so my guess is that if he had untreated syphilis, they would have treated him.  

I realize that this advice if a bit nuanced.  If any part of this reply is unclear or there are additional question, please feel free to use your up to two follow-ups for clarification.  EWH

I went to his home today and asked if he was treated in the past for syphilis. He said he  obviously came in contact but his test is negative. He wasn't treated because according to lab results of beginning October wasn't necessary. 

He said all was fine and I didn't have  to worry. His rpr result is indeed negative but what should I do? He didn't seem to have an ulcer on his penis this week and today I see nothing on his lips. In the mouth I couldn't check of course.

I asked for telephone number and he gave it without hesitation and wanted still to meet me. If he is bad person,I  don't think he would invite me of give his number.He seems trustworthy but I think when someone comes in contact with syphilis one needs antibiotics. He said he didn't but maybe he forgot he'd taken in the past.  His explanation about syphilis is contradictory to me. 

 For his prep he goes to clinic as I mentioned before and the doctor who ordered the lab, I looked her up on Google and that was evidence for me he has his checkups. We have departments in clinics here for infection diseases and for preventing std's. So he goes there regularly.

But how soon can I get tested and should I go to my family doctor for penicillin.? I am scared and confused. Always safe but I feel so stupid about unprotected receptive oral.

Kind regards 

I hope this information is helpful. EWH

Indeed it remains unclear. My family doctor isn't available today, therefore I called other doctors what to do. But due to covid,every doctor is overwhelmed with too many patients and today no appointment possible. The advice from one doctor was check my blood after 1 week and after 6 weeks. Another doctor said after 1 week and after 3 months. I called then the std clinic where he goes and the nurse said blood draw any moment possible and after 3 months. But everyone said no penicillin as preventive treatment. First wait for blood results. If I go to emergency at hospital,they will give me same advice. I made an appointment for next Thursday with my family doctor online. 

What is best time to test and when symptoms? If with positive result after let's say 3 months can I still be cured?

I saw a spot on my tongue, bit sore throat and yesterday headache but that is too soon after 3 days I think?

Kind regards 

In terms of testing, if there are symptoms you are concerned about which have been present more than 2-3 days, testing at that time will tell you whether or not your symptoms are due to syphilis (i.e. when symptoms are due to syphilis, tests are positive).  OTOH, blood tests for syphilis may not turn positive until as long as 4-6 weeks following an exposure so, if you do not have symptoms and want to rule out the possibility of syphilis (which, as I said above, is very low) you'll need to wait until up to six weeks for a definitive test.  

I realize this is complicated.  I hope the information I have provided has been helpful.  this will complete this thread.  EWH