[Question #8684] Syphilis
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41 months ago
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Dear Dres,
I stopped extramarital exposures and tested for HIV, HCV, Syphilis, Gonorrhea and Chlamydia negative just last week. Yesterday I went to a massage again. We were both naked and I received a handjob, sucked her nipple and fingered her vagina for quite a while. Instantly after the feelings of guilt came back to me. I am working on this with a counselor.
While I know my exposure must be "virtually zero risk" I have difficulties to shake off the bad feelings.
My questions:
1.) I guess if at all there is slightest risk, it is for HPV, Herpes and Syphilis, right?
So my only effective slight worry would be Syphilis then (HPV unavoidable and Herpes too and manageable).
2.) If indeed that is the only even SLIGHTEST possible worry, then I can assume that IF that RARE case of a finger infection would happen, a chancre would definitely present on my fingers, right?
3.) I therefore conclude that if that will not happen in the next 3 or 4 weeks that I am EFFECTIVELY and TOTALLY in the clear and not "only" virtually, right?
4.) Therefore testing would EFFECTIVELY be a total waste of time, money and energy, right?
(Taken into account, that I have just been tested for everything.)
I am asking these questions in accordance with the principles I have learned from my counselor. He told me that while clarifying my worries after exposures is OK, I shouldn't be repetitive then. So I hope you can mainly confirm my thoughts on the matter and if I may ask any follow ups I promise to think twice and trice, not to be repetitive.
Kind greetings with a lot of respect and sympathy for the great job that you do!
Karl
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Edward W. Hook M.D.
41 months ago
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Welcome back to the Forum. congratulations on having not returned to the Forum for several months however, I'm sorry you felt the need following the exposure you have described. As you have stated, your concerns are a manifestation of your guilt rather than any meaningful risk for infection:\.
1. There is not meaningful risk with the exposure you describe. no reason whatsoever for concern.
2. In medicine and science we can never say never but the risk is lower than your risk of being struck by lightening while reading my reply. If you were to develop syphilis, a chancre would appear at the site of exposure.
3. Correct
4. Correct- no realistic need for testing of any sort.
I'm pleased that you are seeing a counselor. Take care. EWH
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41 months ago
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Dear Dr. Hook,
thanks for your prompt reply.
Really my only fear is syphilis. But as only my fingers have been „exposed“ without a chancre on my fingers in some weeks an infection is impossible, right?
Kind regards
Karl
PS: I am indeed head of a big German organization and have my academic roots in Management Control (PhD), which focuses on keeping processes under control. Academically socialized like that makes it hard to !accept uncertainty!! That’s a big part of my general problem. No answer expected on that aspect!
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Edward W. Hook M.D.
41 months ago
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I understand the nature of your concern but I must say, it is unfounded. The skin on the fingers is quite different from the surfaces from which syphilis is acquired, being thicker and more cornified. Acquisition of syphilis from the sort of exposure you describe of is unheard of, particularly when your partner is a sex worker professional who thus is likely to be both more knowledgeable and more careful than other partners.
Without a chancre forming on your finger, infection is simply not a possibility.
I appreciate your difficulty in accepting uncertainty but your concerns regarding risk of the low risk exposures which you have described during your interactions with us are less uncertain than many other elements encountered in Management Control. Your concerns are far, far out of proportion to the risk. Let me remind you of a message Dr. Handsfield made related to a prior, similarly low risk encounter- " I
recall your previous comments about your professional stature and
responsibilities. With that in mind, I think it might be time for you to look
for other forms of support rather than this forum. I haven't reviewed all the
previous discussions, but my recollection is that every one concerned events
that you intellectually knew carried little or no risk for HIV or other
infections. All we have done in all those interactions is confirm what you
already knew. I'm not sure how helpful this is to you. Normally we stop
accepting new questions after 2-3 posts on the same theme or topic -- and I
think you're up to 10 or more. Among other things, such questions have low
educational value for other users, one of the forum's main goals."
I insert this reminder because I entirely agree with the sentiment expressed, not only for HIV but for other STIs as well. I offer this input out of interest in your well being. Given your role and responsibilities, you have many things to worry about which are far, far more important then your infinitesimal risk of acquiring an STI, including HIV from the low risk encounter you describe. EWH
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41 months ago
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Dear Dr. Hook,
I am very grateful that you definitely helped me to put matters into proper relations. I am at ease now.
I will focus on the real and important challenges and continue to work with my counselor. Whenever I will feel the need to come back to this forum, I will question myself hard if it is a primarily psychological issue or if STD/HIV knowledge is needed. Only the latter shall me allow to do so.
Kind regards and thanks a lot!
Karl
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Edward W. Hook M.D.
41 months ago
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that is a superb plan. Take care. EWH---
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41 months ago
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Dear Dr. Hook, I remembered that I open mouth kissed a woman of West African origin (Senegal) weeks ago. I had the syphilis screening test after 47 days, nearly 7 weeks after the exposure. Now I have some inflammations at my inner lips and somehow fear that could be oral syphilis from kissing. But how likely could that be that first syphilis would be transmitted by kissing (rare?) and then missed by a test at nearly 7 weeks? I know this has to be my last question for a longer time and I will stick to this rule. Kind regards Karl
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Edward W. Hook M.D.
41 months ago
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This thread should have been already closed.
Syphilis is virtually never transmitted through kissing, even open mouth kissing. Further it would be quite atypical for syphilis to present in the manner you describe and, if it did, to not appear until 7 weeks. Initial primary lessons typically appear by 3 weeks.
I urge you to believe your negative 7 week test results.
Take care. EWH
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