[Question #8686] Syphilis again
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41 months ago
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Hello doctors,
I am sorry to return to the forum. To recap, I had unprotected sex with a few(5) CSWs in London. I had a syphilis test at 101 days after my exposure. But I took 5 days of doxycycline at 20 days after exposure(2 pills every day). Dr Hook told me that my result is conclusive and the doxycycline I took would not affect my test result. However, I saw a recent answer(question8625) by Dr Handsfield that the test need to be done at 3 month after completion of the antibiotics? Would you please help me clarify my confusions? I really want to move on without worry. Am I 100% clear that I don’t have syphilis? Thanks!
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Edward W. Hook M.D.
41 months ago
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My goodness- you are really having trouble letting this go. Our replies are specific to the details of the question asked. My assessment is unchanged. During our last interaction you quoted your 9verly conservative NHS guidelines (in my opinion) to me. Here is the quotation you provided with underlining and bolding added by me:
If initial serology is inconclusive and there is a clinical suspicion, arrange repeat serology a week later and ideally at 6 weeks and 3 months. Avoid the use of antibiotics if possible at this stage if the diagnosis remains uncertain and the patient reports no exposure to syphilis. Treatment at this stage may prevent a serological response. Likewise, if the patient is requiring antibiotics for another reason then this may affect syphilis serology.
Your result was NOT inconclusive and there was NO clinical suspicion, just your anxiety. There is no need for another test beyond the test taken at 3+ months which you have already had. If you do not like that answer, you can certainly get another test which I am confident will once again be negative, proving (once again) that you did not acquire syphilis.
EWH
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41 months ago
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Thank you so much for your help, Dr Hook. I admit my anxiety drives me crazy. When you say clinical suspension, I do not know if I have had a chancre because I didn’t pay attention to it. I notice a small red spot under my left feet, do you think this would indicate syphilis? Considering syphilis is a very dangerous disease. In other words, do I need to look out for symptoms(I have no new sex life yet since the last exposure)? I promise this will be my last question and I will accept your advice. Again, thank you very much for your patience.
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Edward W. Hook M.D.
41 months ago
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No, there is no need to be looking for symptoms. To do so will just fuel your anxiety as the list of symptoms is so long and nonspecific. Further. PLEASE stay off the Internet as it would certainly just further heighten your unwarranted anxiety. You need to move on with your life. EWH ---
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41 months ago
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Thank you Dr Hook. I know this is my last reply. I have two questions:
1. Would you please explain why me case is different from the one in question 8625? Here is what I read in question 8625:
As discussed previously, the chance of syphilis from this exposures was very low, although not zero. Amoxicillin in that dosage probably would abort incubating syphilis, preventing it from ever becoming active. However, it might only suppress the infection, delaying symptoms (which might show up as long as 3-4 weeks after completing amoxicillin) and also delay a positive test result. Assuming no symptoms, you could have a syphilis blood test 3 months after completing amoxicillin -- a negative result at that time would be conclusive.
I would be really grateful if you could explain why in my case I don’t need a test at 110 days(20 days after my doxy course). I really want to avoid testing because that will make me anxious.
2. I just want a last chance for reassurance. In general, how would you advise syphilis testing if some one took antibiotics?
Thank you so much for your help so that I can go through the hard time.
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41 months ago
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Sorry, I meant 90 days after my doxy course.
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Edward W. Hook M.D.
41 months ago
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Final response. Should you return again with further anxiety-driven questions about your low risk exposure followed by negative tests your question may be closed without a response. You asked for expert assessment and got it!
The difference is that the other client took medications starting 10 days after exposure which is during the peak incubation time for development of syphilis while you started your doxycycline at day 20, by which time your infection, had you been infected, would have been established and leading to a positive blood test. Your result is conclusive. If you wish to have another test, you are, of course, free to do so. I am sure that the test will be negative and is unneeded but if that's what is needed to dispell your anxiety over a low risk exposure a person who was unlikely to have a rare disease.
I'll have nothing more to say. EWH
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41 months ago
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I actually not very sure I started doxy at 18/19/20 days， does it make any difference？ Thank you！！！
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Edward W. Hook M.D.
41 months ago
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No. EWH---