I have had seen three CSWs outside of my marriage over the past 6 months. One of these i’ve seen probably on 10 occasions. Sex has always been protected with the exception of oral sex (me reveiving fellatio) as i had always assumed it was a very low risk activity.

Questions

3. i think the stats are around 9,000 positive syphilis cases in the country of circa 60m so higher prevalence than in the US., although i assume still waited to the MSM population. Does this have any bearing on your advice?

Finally, i wouldht have noticed symptoms necessarily as i’m uncircumsized so wouldnt have been checking for chancres , given i assumed it was a low risk activity, and certainly would have missed anythinf on the under-side of my penis.

my concern about testing is that from what i’ve read, false positives are possible which sounds very anxiety inducing and i also dont want to risk my wife seeing a jab mark on my arm which tends to easily bruise.

Thanks 

1. You assume correctly. The main reason I suggested testing is that anxious persons often find a negative test more reassuring than professional opinion, no matter how expert. If somehow I were in your shoes, I would not be tested. However, the frequency of exposure does make some difference -- see my reply to your second question.

2. Ten exposure increases the risk ten-fold. But if that risk is minuscule, then ten-fold higher risk also is very low. And the chance any particular female sex worker in the UK (and most other industrialized countries) is very low. However, with that many exposures, it would make sense for you to be tested. All persons with regular, ongoing non-monogamous sex should have routine STI and HIV testing from time to time, like once every few months or once a year. So if in the last year you haven't had blood tests for HIV and syphilis, or urine test for gonorrhea/chlamydia, it would be reasonable for you to be tested now. You can definitely expect negative results, however.

3. My advice both last time and this time do take into account the low rate of syphilis in the UK, and that most infections occur in MSM.

Although chancres often cause little pain, they do cause discomfort and for the most part are pretty obvious. Even without careful self examination, absence of penile symptoms is strong evidence you do not have syphilis. But false positive results for syphilis are quite uncommon, despite the frequency of questions about them on this or other forums. And false positive results typically are resolved -- i.e. the truth is known -- within a few days. There is no significant risk of needing to speak with your wife on account of a false positive syphilis test -- definitely nothing to be worried about.

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

HHH, MD

1. You mention that if you were somehow in my position you wouldn’t get tested but then say it would make sense to get tested? 

2. i don’t intend to continue this recent behaviour so if i chose not to test would you be comfortable from a risk perspective that the risk is too low from the exposures/situations i have described to be a meaningful concern of risk to my wife?

3.  I have taken Flucloxacillin (contains penicillin) over the past couple of days for bursitis, which i understand would eradicate any current syphillis infection. If i tested in 3 months would the test still show if i had been infected in the past ? i assume it picks up antibodies?

Thanks for this clarification Doctor

2. The risk you have anything is exceedingly low but nobody can say it is zero. For the reason just stated, if you're going to lie awake worrying about it, get tested. It's up to you.

3. Flucloxacillin doesn't "contain" penicillin, but it is in the penicillin class. It likely would prevent syphilis if being taken during exposure or started soon thereafter. But it would not be reliable treatment for established syphilis. Syphilis blood tests are antibody tests. Some but not all remain positive for life, but not all. If you test, ask for an EIA test (for IgG and IgM antibody) -- a negative result will prove you never had it. A negative RPR test would prove you do not now have syphilis, but it can become negative if syphilis is effectively treated and/or contained by the immune system, and therefore cannot guarantee that someone didn't have syphilis in the past.

of things:

1. i said that i met one of these CSWs on 10 occasions but on each of these occasions there were multiple times when she would have performed oral

on me (i.e. NOT just a total of ten oral sex exposures). 

Can i assume that this doesn’t change the risk to any meaningful degree that if you were in my situation you would still choose not to test?

2. My wife fell ill at work yesterday (vestibular migraine) and had various tests carried out at hospital including ‘taking bloods’ - even though syphillis was of course not being tested for specifically, would an infection show and what would it pick up?

She had increased white blood cells in her blood but this is likely due to her testing positive for Covid. 

Just wondering if a general ‘bloods’ test would point to a syphillis infection? 

As an aside, you mention below the issue of testing putting minds/anxiety at ease. My personal case is different in that testing makes me more anxious - waiting for window periods, results, false positive risks etc so would only test if really necessary from medical risk perspective. 

thanks for this final clarification.

j

2. No, standard routine blood tests (CBC, blood chemistries, etc), such as elevated WBC count, do not diagnosis or give clues about syphilis. In any case, it's much too soon for syphilis to be the cause of fever or the other symptoms you describe.

I have no solution to the psychological issues you describe about having tests. All we can do is advise about what tests might be considered and why. The rest is up to you.

That concludes this thread. Please note the forum policy against repeated questions on the same topic. You can be sure there is no additional information that will come to mind that is likely to change our assessment or advice. Thanks for your understanding. Best wishes and stay safe.