Dear Dr. EWH,

I am following up on my post nr 8201.

After the incident I never developed any symptoms on my penis. No ulcers, lesions, or rash anywhere etc. Since there were no symptoms, I never thought of getting myself tested. However, within 2 months of this incident. I also developed Alopecia Areta on my beard. It started with small patch and then gradually increased in size.

These were also the times when I was really stressed and therefore thought, and even told by my dermatologist, that they were result of stress. I am also suffering from Celiac, another auto immune condition, so thought that was too auto-immune nature of my body.

Recently, one of my friend got HSV 2 from a guy. Though the guy used condom, she still caught the virus. This made really wonder and somehow I related my Alopecia to my encounter with CSW.

I even read an article stating that Alopecia can be the only symptom of Syphillis. This made me Panic. I got tested today and waiting for results. I would like to know your opinion. Does STD, specially Syphilis, causes Alopecia? Am I too late get treated? It has been exactly 1 year. Also since 1 year has passed and I have no symptoms, Can i also consider myself safe from HPV warts?  For Alopecia I have been taking local injections. They work to much extend but not complete. I see some new patches growing.

I have other questions which I will post after your response. Thanks!

The secondary stage of syphilis indeed can cause alopecia, but not areata. Syphilitic alopecia is irregular and patchy (sometimes called "moth-eaten") and not sharply demarcated like AA. You can find typical images if you google "syphilitic alopecia" or similar terms. I suppose alopecia could be the only manifestation of secondary syphilis, but very rarely; absence of a generalized skin rash or other symptoms of secondary syphilis is strong evidence your alopecia isn't syphilitic.

That a friend was unlucky and acquired HSV2 despite condo use does not increase the chance you had the same bad luck. (Does it increase your risk of being struck by lightning if it happens to someone you know?)

I have no comment about the treatment you are receiving for your alopecia. AA indeed can occur along with other autoimmune medical conditions, but this is something to discuss with your dermatologist. Also, in your country dermatology and STI expertise usually go hand in hand:  your doctor probably is just as experienced and expert in syphilis and the kinds of hair loss it causes as I am. She would not have started your injections for AA had she had any suspicion of syphilis as the cause.

That said, you should now have a syphilis blood test. Not because I believe there is any realistic chance you have syphilis:  I do not. I suggest it strictly for reassurance, because anxious persons often are more reassured by negative test results than by professional opinion alone, no matter now expert. (We don't take it personally!) If you decide to be tested and would like to return with a follow-up comment to tell me the result, I will be happy to comment further. 

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

HHH, MD

Dear Dr HHH,

Thank you for your reply. I am happy & assured with your response. The only reason I addressed initially to DR. EWH was the fact the he replied to my question before. Other than that, I am equally happy with your expertise.

I have some concerns for which I require your guidance. I was in long distance relationship that ended. Even then my sexual activity was very limited, 2-3x in 2-3 months with condom. I always ensure that my penis is completely covered.

Now, I am single. I am really looking to be with another partner. Usually I find my partner through online apps or events or clubs or anyway social possible. But fear of STD has completly taken over my mind. The following are my concerns.

If someone doesnt have a visible sore on her lips, and if I kiss her passionately, what are the chances that she can transmit Oral herpes to me? I have NEVER had cold sores in my life. How the chances when someone kiss a girl whose sore may have missed to notice. Is oral herpes so easy to transmit? do sore occur inside mouth? same scenario for hsv2.

If I wear condom properly to the base, what are the chances acquiring genital warts . I have taken Gardasil9 1st dose last week. Will it make sufficient antibody if I get intimate with someone with condom after 14 days. Does skin to skin contact for HPV mean outerskin or just vaginal inside skin?

I apologoze Dr. if these question are overwhelming but I request for your understanding & expertise.

The chance of oral herpes from any particular kissing event probably is under one chance in many thousand. And if you have had HSV1 yourself, as has half the US population and up to 90% in some countries, you are immune to a new infection. Absence of cold sores means nothing; most people with past HSV1 have no symptoms. But even if you have not had HSV1, any kiss is very low risk, although not zero.

Condoms reduce the chance of catching HPV by around 70% on average. Your risk will be lower if careful about avoiding skin contact above the condom, but that can be difficult. If you have many such exposures over time, even with consistent condom use, you can expect to catch genital someday. Skin contact away from the genital area is risk free for HPV and all STIs.

Dear Dr. HHH,

I thank you for your help and guidance. The only reason I was not able to put all question in the first place was that there was word/character limit. But I still thank you for your help and apologize for any inconveniences.

My last question would pertain to HPV warts. What is typical window period for HPV warts to appear when exposed. Do all exposures to HPV lead to transmission ?

My last exposure was with my gf 8 months back with condom and no genital touching of penis. The one I open this question was 1 year back with condom. Since then no symptoms of genital wart.

Can I consider myself well-protected after 14 days of 2nd dose of Gardasil9 assuming I may have not acquire HPV before? 

I thank you again for your help.

Warts can appear as soon as 6 weeks, but usually they show up after 2-6 months, sometimes up to a year.

And yes, the HPV vaccine (Gardasil) is nearly 100% protective 2 weeks after the second dose. You should still have the third dose at 6 months, to prolong your excellent immunity to HPV.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.

By the way, users are asked to have only one account and a single username. This one is different than for your question a year ago (8201). If you need to return someday, please stick with this one. Thanks.