[Question #8858] Question
39 months ago
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Hello Doctors:
I reached out a few months ago about a one-time unprotected vaginal exposure and testing for chlamydia and gonnorhea which came back negative. Additonally, I tested for HIV which came back negative as well. However, I didn’t test for syphillis at the time and wondering now if I should despite the lower probability of transmission in women to men.
My one time exposure was back in October and have had no noticeable symptoms which includes the absence of a chancre at the site of infection. I’m uncircumcised and was diligently watching for a possible onset 3-4 weeks after exposure. Also, I haven’t developed any type of rash which would indicate a secondary infection. Usually, located on the palms of the hands or feet. However, it is known as the great immitator so it could occur other places such as the torso etc.
Since my possible exposure, I’ve had unprotected sex with my partner after testing back in late February 15 or more times. She recently had a syphillis screening in mid-May and tested negative.
Provided this information, do you think further testing is required? The logical side of my brain is saying no but wanted additional confirmation from experts in the field before putting it to bed.
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H. Hunter Handsfield, MD
39 months ago
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Welcome back and thank you for your continued confidence in our services.
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You can be extremely confident you did not acquire syphilis. But I think you should be tested anyway, for two reasons: First, syphilis testing is pretty much automatic and routine whenever anyone is evaluated and tested for any STI. My guess is you arranged your own testing after the exposure, right? All STI experts and most other health care providers would have included syphilis testing had you sought their advice. Even when the chance is extremely low, it's a dangerous infection if not properly treated. Second, the very fact that you ask about testing suggests you should do it. Since it's on your mind, it seems likely you will remain at least a little bit concerned no matter what I say.
Do I think you really need testing from a medical or risk standpoint? No -- only for reassurance, as just implied. So feel free to skip it if you don't feel the need. The two main reasons I am confident you don't have it are that the chance any particular female partner in the US or other industrialized countries is extremely low; and you are correct that absence of a chancre at the site of exposure (your penis) strongly suggests you were not infected. Presence or absence of a rash suggesting secondary syphilis and your regular partner's recent negative test don't really mean much one way or the other; at best those facts are only mildly reassuring.
In summary, the "logical side" of your brain is right, but that doesn't mean you should ignore those nagging concerns. If you go ahead with testing, you can definitely expect a negative result.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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39 months ago
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Thank you, Dr. HHH, for your detailed reply.
You are correct in your assumption that I did not go the traditional route for testing as you mentioned a basic panel screening would have already included this.
While I knew my test result would return negative; I'm glad I reached out to get the extra "nudge" for further testing to completely eradicate any lingering concerns.
I moved forward with testing yesterday and received a non-reactive test result.
Despite having to pay a little extra money, the peace of mind after going back in forth over the last 6 months is worth the investment and knowing my partner is safe is priceless.
One last question: I've tested for Chlamydia, Gonorrhea, HIV and now Syphilis. Would there be any other tests you recommend taking for my brief one-time exposure? I have shown no symptoms to date to indicate any complications otherwise as it would relate to NGU's etc.
Thank you again for helping me fight the battle between my ears and hope you have a wonderful holiday weekend.
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H. Hunter Handsfield, MD
39 months ago
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You have had all the testing needed; I don't recommend any others. There is no test for NGU -- diagnosis is based entirely on symptoms and exam. And anyway, if you had acquired NGU 6 months ago, it would be gone by now.
Thanks for the thanks.
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39 months ago
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Sounds good. Please close this thread.