[Question #9159] Syphilis test, delay and AB
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35 months ago
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This is a follow-up question (#8983) and specifically for Syphilis as I do have a few question about the testing reliability in combination with antibiotics I had to take due to a bacterial skin infection. Exposure: received a blowjob for about 1 to 2 minutes from masseur as mentioned in #8983 about 11 weeks ago, no other sexual activity has taken place.
Due to a not related bacterial skin infection (27 days post exposure) I had at to start with Flucloxacilini 500mg 3 times per day. Because this AB did not seem to work after two 2 days (skin infection did not became less) I had to stop it and start using Clindamycin 600mg 3 times per day for 10 days.
1 day after I started with Flucloxacilini, 28 days post exposure I took the HIV and Syphilis bloodtest (report mentions TPPA and serology). which came back both negative. At 8 weeks I repeated both tests and came back negative. During the last 11 weeks post exposure I did not see any lesion on my penis and I checked it very carefully on daily basis. Today I went for another Syphilis test at another clinic, it comes in a package with HIV and Hep B/C and expect results tomorrow.
So timeline:
Day 1: Exposure
Day 16: HIV PCR RNA test negative + gonorrhea/chlamydia urine test negative.
Day 27: Start Flucloxacilini (3 pills of 500mg)
Day 28: HIV 4th and Syphilis bloodtest (report mentions neg. HIV and neg. TPPA and serology "no actual infection found")
Day 29: Start Clindamycin 600mg 3 times per day for 10 days (and stopped Flucloxacilini).
Day 55: HIV 4th and Syphilis bloodtest (report mentions neg. HIV and neg. TPPA and serology "no actual infection found")
Day 71: short unprotected sex with my girlfriend
Day 78 (today): HIV 4th + Syphilis + Hep B/C (waiting for the result)
The questions I have:
1. Could the antibiotics I had to take from day 27 make my Syphilis test at 4 or 8 weeks results less reliable and mask/delay Syphilis? With other words: could the "6 weeks" conclusive testing not count in my scenario due to the AB?
2. At 71 days post exposure I had minor sex with my girlfriend, where she was sitting on top me and used my penis to rub her vagina (not entering it, only the top) and afterwards I ejaculated towards her vagina. I have no visible lesions (and still have no at day 78), I checked it multiple times, could if even possible that I have Syphilis, this infected her?
3. Is a new test (after the one from 78 days) still needed? And if so, when can I stop testing (in case the antibiotics are making the tests still not 100% conclusive?)
4. I'm most concerned about my girlfriend and if I can trace back an infection by myself (which then needed to be a cured by the given AB at 4 weeks?). So can I EVER traceback I was infected? Even when all my tests stay negative? The reason I'm asking is: I do not want to tell her, if not needed off course, about the massage event.
Due to a not related bacterial skin infection (27 days post exposure) I had at to start with Flucloxacilini 500mg 3 times per day. Because this AB did not seem to work after two 2 days (skin infection did not became less) I had to stop it and start using Clindamycin 600mg 3 times per day for 10 days.
1 day after I started with Flucloxacilini, 28 days post exposure I took the HIV and Syphilis bloodtest (report mentions TPPA and serology). which came back both negative. At 8 weeks I repeated both tests and came back negative. During the last 11 weeks post exposure I did not see any lesion on my penis and I checked it very carefully on daily basis. Today I went for another Syphilis test at another clinic, it comes in a package with HIV and Hep B/C and expect results tomorrow.
So timeline:
Day 1: Exposure
Day 16: HIV PCR RNA test negative + gonorrhea/chlamydia urine test negative.
Day 27: Start Flucloxacilini (3 pills of 500mg)
Day 28: HIV 4th and Syphilis bloodtest (report mentions neg. HIV and neg. TPPA and serology "no actual infection found")
Day 29: Start Clindamycin 600mg 3 times per day for 10 days (and stopped Flucloxacilini).
Day 55: HIV 4th and Syphilis bloodtest (report mentions neg. HIV and neg. TPPA and serology "no actual infection found")
Day 71: short unprotected sex with my girlfriend
Day 78 (today): HIV 4th + Syphilis + Hep B/C (waiting for the result)
The questions I have:
1. Could the antibiotics I had to take from day 27 make my Syphilis test at 4 or 8 weeks results less reliable and mask/delay Syphilis? With other words: could the "6 weeks" conclusive testing not count in my scenario due to the AB?
2. At 71 days post exposure I had minor sex with my girlfriend, where she was sitting on top me and used my penis to rub her vagina (not entering it, only the top) and afterwards I ejaculated towards her vagina. I have no visible lesions (and still have no at day 78), I checked it multiple times, could if even possible that I have Syphilis, this infected her?
3. Is a new test (after the one from 78 days) still needed? And if so, when can I stop testing (in case the antibiotics are making the tests still not 100% conclusive?)
4. I'm most concerned about my girlfriend and if I can trace back an infection by myself (which then needed to be a cured by the given AB at 4 weeks?). So can I EVER traceback I was infected? Even when all my tests stay negative? The reason I'm asking is: I do not want to tell her, if not needed off course, about the massage event.
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35 months ago
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To make question 4 more clear: can I trace back any historical infection (so from the last 11 weeks) so I can warn my girlfriend she needs to get tested if it would be positive.
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Edward W. Hook M.D.
35 months ago
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Welcome back to the Forum. Thanks for your questions. On this occasion I happened to pick up your question and will be answering. In preparing to respond I reviewed your earlier interaction with Dr. Handsfield and agree with all he said- this was a virtually no risk encounter in terms of HIV risk and a very low risk encounter for other STIs. Straight to your follow-up questions:
In general, your risk for syphilis from the encounter you desribe is very, very low- syphilis is virtually never transmitted by receipt of masturbation and most unusual following receipt of oral sex
1. If you had acquired syphilis, the antibiotics you took on day 27 could have impacted the result of your syphilis test. Flucloxacllin is a penicillin type medication and would be active against syphilis. Clindamycin has less activity against syphilis. The amount of flucloxacillin you took however would not have cured syphilis, had you acquired it and both your day 55 and certainly your day 78 syphilis tests would have been positive. I am confident that your day 78 syphilis test will be negative however and when it is, it will be time for you to put your concern about syphilis aside and not worry (or test) further.
2. If not lesion was present, there is no risk to your girlfriend. Syphilis is transmitted by direct contact with lesions
3. When your day 78 test is negative, as I am sure it will be, there is NO need for further testing
4. when your test is negative, you can be confident you never had syphilis. No risk or concern for your girlfriend
I hope these replies help, I see little to worry about here. EWH
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35 months ago
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Thank you Dr. Hook for your detailed answer, that helps a lot! I do have a few follow up questions that would probably answer my final (anxiety driven) thoughts. Thanks in advance!
I just received my results from the 78 day test: all negative, so that's good news!
1.
How much Flucloxacillin is required to cure Syphilis? Would 8 pills in
total (I mentioned earlier I took 6 in total, 3 per day) makes a
difference in your opinion that it would not cure Syphilis? I found that
8 pills in total is what I took in 3 days (2 at day 27, 4 at day 28 and
2 at day 29). Could it cause a false negative test at 55 or 78 days or
does it require a new test later? I read in a few answers on this site
that partial treatment (with Doxy) of Syphilis could interfere with
testing and requires later testing.
2.
IF the 8 pills of Flucloxacillin (perhaps with the combination of
Clindamycin) would have cured Syphilis, would that mean it was cured
totally and not transmittable the days/weeks after I took the last pill
(day 28) and my 55 day test is a true negative? With other words: is
there ANY change (with my negative tests at 28, 55 and 78 days) I still
could have infected my girlfriend at day 71? This is by far my main
concern!
3. When I
want to be sure I never (from whatever time) had Syphilis for 100% (to
be sure I could never infected my girlfriend at day 71). What test type
would show that? Is it TPPA (which I had at 4 and 8 weeks)? And after
which time would that be? Or do the test I had so far already conclude
for 100% I never had a cured Syphilis?
4.
Does Fusidic acid cream have any influence on testing or cure? Or could
it made lesions go away before I could see them? I forgot to mention my
GP gave me, 6.5 weeks after exposure, that because I had some (3 or 4)
pimples on the head of penis (1 to 2mm, never changed in size). GP
inspected it and told me those were probably cause due to the AB.
5.
If I had acquired syphilis (and missed a lesion) and if the given AB
would have cured syphilis would in that the 55 or 78 days test be
positive because antibodies would be found anyway? I read about that,
and that while being tested you have to tell the clinic if you had
Syphilis before (for the type of testing they apply) and to save time in
the lab.
My
questions are probably a bit repetitive but it would help me to
understand the way testing is done and how the working of antibiotics
applies to my timeline, and finally to put this behind for once and for
all.
Many thanks again! Your help and expertise is highly appreciated!
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Edward W. Hook M.D.
35 months ago
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Straight to your follow-up questions:
1. Syphilis is typically treated with 10 or more days of antibiotics. Shorter courses may work but no one would do studies to find out just how little therapy is needed. 8 pills over two or threes is not enough to necessarily cure syphilis. It is far more likely that you never had syphilis. Your test results PROVE this.
2. You're having trouble letting go of this. Your results show that you were not infected, not that the antibiotic you took cured the infection
3. Same question again and again. Your test results PROVE that you were not infected. There are no better tests.
4. Fusidic acid is not known to have activity against syphilis.
5. If you had acquired syphilis and missed the lesion, your tests would have been positive and stayed positive. Again, there is NO EVIDENCE that you ever got syphilis
I urge you to believe your test results. EWH
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35 months ago
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Again, thanks a lot Dr. Hook! I know my previous questions were very repetitive and apologies for those!
It is just my lack of knowledge why I don't understand (or know how to interpret) the test results with respect to your comment "NO EVIDENCE that you ever got syphilis".
In fact you say, if I understood correctly: if you would have been infected and cured the test would have shown that (and that would be reported to me), and the tests also show you do not have an active infection (and I won't have one in the future due to my expose 11 weeks ago). Correct?
Thank you Dr. Hook and also Dr. HHH for your expertise, the follow-up questions and all the effort you put in this site. I had 3 terrible, anxiety driven, months due to the exposure I had, but it is now time to let it go and continue with my life.
Wishing you all the best!
It is just my lack of knowledge why I don't understand (or know how to interpret) the test results with respect to your comment "NO EVIDENCE that you ever got syphilis".
In fact you say, if I understood correctly: if you would have been infected and cured the test would have shown that (and that would be reported to me), and the tests also show you do not have an active infection (and I won't have one in the future due to my expose 11 weeks ago). Correct?
Thank you Dr. Hook and also Dr. HHH for your expertise, the follow-up questions and all the effort you put in this site. I had 3 terrible, anxiety driven, months due to the exposure I had, but it is now time to let it go and continue with my life.
Wishing you all the best!
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Edward W. Hook M.D.
35 months ago
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As per Forum guidelines, this reply to your repetitive, anxiety driven questions will complete this thread.
Correct. Treponemal syphilis tests such as the TPPA stay reactive for life, irrespective of treatment, in persons who acquire syphilis. Among persons who acquire syphilis there are other tests which allow clinicians to determine whether a person has responded to therapy or become reinfected. Your tests clearly show that you never had syphilis.
Please believe your tests and move forward. EWH
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