My concerns are HIV and Syphillis. The HIV test was a 4th generation, and Syphillis was a CMIA- both non reactive.

7/16/22- 71 days later I have a red papule bump on the underside of my penis head and I am concerned it is the beginning bump of a syphillis ulcer as it has only been three days since it formed.

Would you consider my results conclusive and this red papule unrelated?

Would this delay or affect HIV testing window.

Would it affect my bodies response to Syphallis and cause a delayed reaction resulting in a chancre 10 weeks after the exposure?

Would aquiring HIV simultaneously delay chanre production?

You have neither syphilis nor HIV from the encounter described. Several reasons:  Even among relatively high risk persons, such as men who have sex with men and have multiple partners, at any point in time the large majority have neither infection. Second, neither is readily transmitted by oral sex; in fact, there has never been even a single scientifically documented case of HIV transmission oral to penis. Third, the tests you had are highly reliable. The HIV test for sure is conclusive -- 6 weeks is the time for the HIV antigen-antibody (AgAb, i.e. 4th generation) tests, and 41 days is close enough. The syphilis test is perhaps not quite conclusive -- there's a bit of uncertainty here:  although almost all newly infected people would have positive results by 41 days, on rare occasions it may take 8 weeks, and some experts even recommend 3 months. But the combination of low risk plus that test result is conclusive for all practical purposes.

The red lesion on your penis came on much too late to be syphilis from the exposure described, and the description is not consistent with primary syphilis. Hard to say what this might be, but I'm confident it isn't syphilis. But if it persists, enlarges, or ulcerates, of course get seen professionally for evaluation.

I'm sorry to hear of your covid experience, but glad you have recovered. It has no bearing on your test results. There are no known medical conditions or medications that have any effect on the reliability or timing of the tests you have had, and that includes COVID-19. And acquiring HIV has no known effect on development of syphilis chancres or other symptoms.

So all is well -- but get seen professionally if the penile lesion persists.

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

HHH, MD

The fact you mention the lesion came on too late makes me feel better; however, would the 71 days not fall into the 90 day incubation period? And therefore make it possible this is syphillis?

Finally, on the off chance this somehow is syphillis, and this is a new chancre that has developed- Would I have been infectious up until this point? I ask because after my results came back negative, I had unpretected sex with my spouse and I am extremely nervous I could have exposed her.

Normally threads are closed after two follow-up exchanges and we're there. But I'll leave this open for a while in case you decide to re-test, and/or if the papule is professionally evaluated, and you would like to let me know the results. But I won't have any other comments or advice without that information.