I’m a male and had an experience with a woman who forcefully engaged in unprotected sexual acts on me and it’s been scarring for me. It has not been easy. Long story short, I need some medical advice.

I’ve been very worried about syphilis and hiv and have been tested numerous times. I have had…

HIV Tests

HIV RNA at 21 Days and 42 Days

HIV 4th Gen at 42 Days, 63 Days and 112 Days

Syphilis Tests

RPR at 42 Days, 77 Days and 112 Days

EIA at 63 Days and 90 Days

I was on a short course of Doxycycline at the 70 day post exposure mark but it was only 100 mg once per day for 10 days for a bacterial infection not pertaining to this event. 

From what I have read, I’ve been over tested for HIV but wanted to clarify that with you. Second, I have had no symptoms of syphilis besides a white mark that was semi inflamed on the inside of my gum at day 71 post exposure, it was never red or ulcerated and it never an open sore.  But I only noticed the white mark  when I started the Doxy. 

My questions…

1) If the white mark was a chancre,  could it have begun at 71 days and even on Doxy? It would be too late for primary syphilis, correct? 

2) Have I been over tested for both HIV and Syphilis?  Being tested almost 5 weeks after my course of Doxy with an RPR at 121 days post exposure seems like it’s strong evidence that I don’t have it but I’m still worried that somehow I didn’t produce/delay antibodies after my short course of doxy.

3) Should I seek counseling for my anxiety? I lie awake worrying about how a test could be falsely negative.  I’ve done everything to make sure I’m negative but I need to know if my results can be trusted and are conclusive.

Thank you in advance. Your help is appreciated. 

 

You don't say anything about your partner's sexual lifestyle, STI history etc, so I can't judge the likelihood she is infected. You also don't mention the specific exposures (vaginal? anal? oral? condom use?) which of course influence STI risk. But even among the highest risk women in industrialized countries, at any point in time most have no active, transmissible STI; and most STIs are inherently inefficiently transmitted, i.e. most exposures to infected partners don't result in transmission. For example, a CDC calcluation is that on average a single episode of vaginal sex with an HIV infected female, not on treatment, has an average risk of one in 2,500 for her male partner.  And there is no particular reason to assume that the vigor or aggressiveness of any particular exposure indicates either your partner's risk of having an active STI or the likelihood of its transmission. 

As for your test results, they are conclusive. You have been way overtested:  there was no need or point in HIV testing beyond the 6 week (42 day) AgAb (4th generation) blood test, or beyond your negative syphilis tests at 42 adn 63 days. The results overrule all other considerations:  regardless of what symptoms you have now or may develop in the future, they are not due to HIV or syphilis, no matter now typical of those infections they might seem to be.

That said, you don't mention testing for gonorrhea or chlamydia. Both are far more common than syphilis or HIV in this situation. If your partner has had any other partners at all, then regardless of condom use you should have had urine or urethral swab tests for both organisms.

Those comments pretty well cover your first two questions (and maybe the third), but to be explicit:

1) Yes, too late for primary syphilis. Chancres never develop later than 4-5 weeks after exposure, and cannot develop while taking doxycycline, which is highly active against Treponema pallidum, the cause of syphilis.

2) Yes, overtested -- see above. There is no such thing as anyone not being able to produce antibodies. The only rare exceptions are certain kinds of congenital immunodeficiency -- of the sort that would have killed you before your teen years. (Think of the past media stories about "the bubble boy" and similar situations.)

3) You're the only one who can decide whether you would benefit from couseling or other professional help for your anxiety about all this. All I can say is that being at all fearful about STIs at this point (especially HIV and syphilis) has no scientific basis. I would also add that most people who even ask this question indeed would benefit from professional advice, especially if my advice doesn't settle things for you once and for all.

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

HHH, MD

Just out of curiosity, Levofloxacin would have no affect on syphilis either? 

And yes, I have a full std panel test at 6 weeks so all of the remaining were ruled out. 

Thanks for your response 

Levofloxacin and all drugs of its class (fluoroquinolones) have no activity against T. pallidum and syphilis and hence no effect on test timing or reliability.

I’m tempted to get tested for Syphilis one more time to ease my anxiety. I know you said that I am over tested and I trust you but the long testing window range of Syphilis scares me. I have had no symptoms or rash besides a white inflamed mark on my gums beginning when I first started the short course of doxy as I wrote. That is what I keep coming back too and scares me since I know a short course of antibiotics can affect a test.

It’s almost been 6 months now since the event. I really want to put this behind me. I probably would be in some medical literature if I did somehow become positive from that event and with being over tested with negative results that I stated in my previous post, correct? There is no possible way for me to have Syphilis being tested all the times that I have been? 

Thanks, I just need to put this behind me.

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