[Question #8729] Oral Syphilis from French Kissing
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40 months ago
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Hello Drs,
I'm sorry to come back to the forum so soon but a recent development has caused me to have some new concerns. I had unprotected mutual oral sex with a woman (not my partner on December 15th). Tested for syphilis, HIV, Hep B (all at or after 90 days), gonorrhea, chlamydia and Trichomoniasis (negative). I also had mutual masturbation with the same girl on 24th Feb with exchange of fluids.
The advice I received here was enough to put my mind at ease. However, one thing I didn't mention was on 24th Feb and 8th March, I engaged in french kissing with this girl. I now have some red patches on my tongue and am concerned as I've read that syphilis is transmittable through kissing. I'm not sure if this is indicative of syphilis or geographic tongue (red patches surrounded in white and the shape changes on all but one of the sites frequently). I did have some similar issues in December.
I also have a small red patch on the inside of my upper lip, not in a location where I could have bitten it. It's red and maybe a couple of millimeters wide. I can very faintly see two dots within this (maybe yellowish). My last syphilis test (EIA) was taken on 15th March and was non-reactive. The girl was last tested on 28th Feb and was negative. She has a long-term partner who she suspects has been unfaithful in the past and maybe still is.
The last time they had penetrative or oral sex was Decemeber 4th. Since then they've just kissed and she's given handjobs. Here are my questions.
1. If she did happen to be infected, what are the chances of me catching it through kissing on those 2 occasions.
2. Is 6 weeks a reliable window for testing? I've seen Dr Handsfield mention on healthtap that it may be too soon and might not show until possibly 8 or even 12 weeks?
I'm sorry to come back to the forum so soon but a recent development has caused me to have some new concerns. I had unprotected mutual oral sex with a woman (not my partner on December 15th). Tested for syphilis, HIV, Hep B (all at or after 90 days), gonorrhea, chlamydia and Trichomoniasis (negative). I also had mutual masturbation with the same girl on 24th Feb with exchange of fluids.
The advice I received here was enough to put my mind at ease. However, one thing I didn't mention was on 24th Feb and 8th March, I engaged in french kissing with this girl. I now have some red patches on my tongue and am concerned as I've read that syphilis is transmittable through kissing. I'm not sure if this is indicative of syphilis or geographic tongue (red patches surrounded in white and the shape changes on all but one of the sites frequently). I did have some similar issues in December.
I also have a small red patch on the inside of my upper lip, not in a location where I could have bitten it. It's red and maybe a couple of millimeters wide. I can very faintly see two dots within this (maybe yellowish). My last syphilis test (EIA) was taken on 15th March and was non-reactive. The girl was last tested on 28th Feb and was negative. She has a long-term partner who she suspects has been unfaithful in the past and maybe still is.
The last time they had penetrative or oral sex was Decemeber 4th. Since then they've just kissed and she's given handjobs. Here are my questions.
1. If she did happen to be infected, what are the chances of me catching it through kissing on those 2 occasions.
2. Is 6 weeks a reliable window for testing? I've seen Dr Handsfield mention on healthtap that it may be too soon and might not show until possibly 8 or even 12 weeks?
3. Is my partner at risk from me kissing her?
4. Does this warrant testing?
5. Do you have to come into direct contact with a chancre to get infected? Is it transmissable if no chancre is present?
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40 months ago
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Sorry, I also forgot to mention that I'm about to start taking Scheriproct suppositories for anal inflamation. Can these affect any STI test results (false neg or false positives)?
Many thanks.
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H. Hunter Handsfield, MD
40 months ago
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Welcome back, but I'm disappointed you found it necessary. I reviewed your two recent discussions with Dr. Hook and agree with his assessment and advice. You had an exceedingly low risk sexual experiene. As for kissing the same partner, kissing of course is (and widely understood to be) no risk for any STI, or low enough risk that it can and should be ignored. Can you imagine the hundreds of times more common STIs would be if kissing regularly transmitted them?
As you have learned, there is controversy and uncertainty about timing of reliable syphilis testing. Six weeks probably is plenty, but because of uncertainty --and variability between different types of screening tests -- conservative advice is often to wait 8 or even 12 weeks. However, it is exceedingly rare for it to take that long. More important, there are several reasons other than the blood test results that you should be confidence you do not have syphilis. They start with the fact that syphilis is exceedingly rare in women in most industrialzied countries, and even lower in the UK than most (such as the US). There is little chance your partner had syphilis, or that even if she did, you could have caught it. Please believe, understand, and accept that judgment and ignore any and all symptoms that have occurred or that might occur in the future. They will not be syphilis, which you do not have. To your questions:
1. No risk.
2. See above.
3. No. You cannot transmit an infection you do not have.
4. No further testing is needed or recommended.
5. Yes, syphilis can be transmitted from certain asymptomatic sources, i.e. in absence of a chancre. But as implied above, we're speaking of things whose chance in the same range as the possiblity you'll be struck by a meteorite. (I thought of using the lightning analogy, but that would be far higher.)
I am unfamiliar with "Scheriproct", but on quick search I see it contains low dose hydrocortisone and other agents that cannot affect the test results you have had or might decide to use in the future.
I'll close by repeating again that our opinion you have neither syphilis nor any other STI is not dependent primarily on the test results. Please re-read all of both Dr. Hook's previous replies and my own to understand the full basis for our opinions and advice. Please avoid the temptation to keep coming back with more questions about the exposures described. Feel free to return when you start having unsafe sex that actually puts you at risk.
Sorry if this sounds like an insensitive lecture. Maybe it is, but I view it as a version of "tough love". Do your best to suck it up and move on!
HHH, MD
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40 months ago
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Thank you, Dr. I'm on the autistic spectrum so please accept my apologies for my obsessiveness over this.
My worries didn't lie in the incident on 15th December - I've finally been able to let go of that thanks to Dr Hook and my test results. The doubt was put in my mind by the fact the girl was tested on 28th Feb but we kissed on both 24th Feb and 8th March. This led me down the path that her test would clear her from mid January but had she contracted something between that date and the two dates we kissed it could have put me at risk. I hadn't considered this until the patches on my tongue and the red spot on my upper lip.
As my last test was taken on 15th March, presumably this wouldn't be enough time to test positive if I did contract something.
The explanation you've provided as to why the risk is so low has certainly gone a way to helping but if I could bother you with a couple more questions it would be of a great help.
1. Am I correct in thinking that multiple discoloured patches on a tongue could be ignored as they'd be likely to be a symptom of secondary syphilis (which my earlier tests rule out) rather than a new infection?
2. If a chancre were to appear would it start off as a red patch then escalate into an ulcer? How quickly does this process take after initial redness has appeared?
3. From you personal experience have you ever encountered anyone who has obtained syphilis only from kissing?
Her partner's previous sexual history is the only thing driving this. I know she hasn't been with anyone else but she's been suspicious of him for a while.
Many thanks
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H. Hunter Handsfield, MD
40 months ago
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1. Correct: Such tongue patches are not a possible symptom of newly acquired syphilis, only of secondary syphilis, i.e. infection acquired at least 2-3 months previously.
2. No. Chancres to not behave in this way.
3. No, I have not. But of course that is irrelevant: rare things happen. I've never cared for a patient struck by lightning, but does that have any influence on your risk of being struck?
As far as your partner's "previous sexual history", you say nothing that implies she is at particularly high risk for syphilis or any other STI. Just having an unfaithful partner doesn't necessarily imply high risk in general and certainly not for syphilis.
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40 months ago
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Thank you so much for your response. Just to clarify:
1. The period from the first kiss on 24th Feb to onset of the red patch on my tongue on 3rd April (total of 38 days) would be 100% too early to be secondary syphilis? (patch has continued to expand and my dentist has referred me to hospital for further examination).
And finally just some general queries should I ever have a situtation in the future:
2. How long from onset of symptoms would a test turn positive?
3. Does any stage of syphilis cause a sore throat?
4. I came across a case on https://www.researchgate.net/publication/300081923_Syphilitic_Chancre_of_the_Lips_Transmitted_by_Kissing_A_Case_Report_and_Review_of_the_Literature from 2016 which stated that they believed this is the first reported case of syphilis transmission by kissing. Is it really that rare? CDC literature reads as if it were more common. Is their info based more on theoretical risk than real world cases?
Thank you so much for your time and patience.
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H. Hunter Handsfield, MD
40 months ago
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Secondary syphilis symptoms, including mouth and tongue lesions, conceivably could begin as soon as 38 days after acquisition of the infection, but if this ever occurs it is exceedingly rare. In addition, as you already understand, syphilis transmission by kissing is rare. Third, syphilis is rare in women in North America or Westen Europe, so it is statistically unlikely your partner had syphilis. Fourth, the chance secondary syphilis would show up only mouth lesions is also nearly zero. For the sake of calculation, let's assume each of these four predictors has one chance in a thousand of happening. Now let's calculate the the odds you have syphilis. Mathematically, it's 0.001 x 0.001 x 0.001 x 0.001 = 0.000000000001. If I have correctly counted my zeros, that's one chance in a trillion. (And even if each of these events is actually 10 time more common than my estimates -- i.e. 1% chance instead of 1 in a thousand -- it would come to a risk of 1 in 100 million.)
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By contrast, according to the National Safety Council, an injury prevention organization, the average person living in the US has 1 chance in 1,756 of dying accidentally (auto accidents, falls, drowning, etc, etc) per year. This means that the chance you will die accidentally by this time next year is around 570 million times higher than the chance you have syphilis (again, if I've counted my decimal places correctly). Surely this will be reassuring, regardless of how far along "the spectrum" you may be. If not, have a syphilis blood test. If your tongue problem is syphilis, the blood test will be positive: there has never been a known case of secondary syphilis with a negative blood test, regardless of its duration. So my advice is to stop worrying about syphilis -- and don't forget your seatbelt!
1. See above.
2. Within 1-2 weeks of chancre onset.
3. No.
4. There has never been any doubt that syphilis can be transmitted by kissing. Many agencies indeed often include theoretical but rare risks when providing prevention advice, especially in litigious societies like ours.
That completes this thread. Please do not start a new one on this topic. Repeated questions on the same topic are not permitted, especially when so obviously anxiety driven. Another will be deleted without reply, and without refund of the posting fee. This policy is intended to reduce the temptation to keep paying for quesitons to hear the same answers. Also, repeated questions and replies often fuel anxiety rather than resolving it. Finally, such questions have low educational value for other users, one of the goals of the forum.
But I do hope this discussion has been helpful and that you'll move beyond these fears with no further worry. Good luck.
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