Good evening.  Awhile back, I asked a question about having sex with a woman in the Caribbean who is a secretary and does some part-time sex work.  I have seen her from time to time in a non-monetary relationship.  I had inquired about the chance of an STI, and your response was "low risk."  I recently asked her to take an STI test.  She received an overall review of her health and was told she had a vaginal infection.  She was prescribed amoxycillin and also received a blood test.  The next day, she received a penicillin injection which she said was to "clean out her system."  My understanding is that penicillin is used for syphilis.  Prior to the test, we had penetrative sex with a condom that was properly worn.  Based upon these new facts and circumstances, how significant do you think the "syphilis" risk is?  Thanks.  

Welcome back to our Forum.  My opinion of your exposure has not changed.  This was a low risk event.  Have faith in your condom which, even in the unlikely event that your partner had syphilis, would greatly reduce your risk of infection.  As for the penicillin injection, sadly, all too often health care providers give concerned or at risk patients medications "just in case" an infection is present.  When they do, they tend to give relatively inexpensive medications; penicillin is inexpensive.---

Thanks for the response.  Just to be clear, this event was within the past week (not 30 days ago).  Can I assume skin to skin contact of syphilis is relatively uncommon?  Is there any reason to avoid sex short term?  Actually, I probably should just keep faith will keep the faith and forego the testing rather than obsess about it.  Thanks.

Thanks for the clarification. I had thought you were talking about interactions that you mentioned when you came to the forum about a month ago. With your clarification, it becomes important to know whether she received penicillin because of test results received after she was seen at the doctor or not. Specifically it would be important to ask her about the results of her test for Syphilis. Syphilis remains unlikely for all the reasons I mentioned during our earlier interactions but one has to wonder why She was called back to receive additional penicillin on top of the amoxicillin she already received. Some level of concern is warranted and more information would be most helpful. EWH---

This is #3, and I am precluded from using this system for another six months, so I will try to be as comprehensive as possible.  I guess the question would be whether I receive an honest answer from the woman, so I will ask the following based upon an assumption she was infected.   In a separate post a couple of months ago, you had indicated that penetrative sex with a condom was very very low risk for an STI.  Does your current observation indicating that the facts this time warrant some level of concern modify your earlier risk assessment of very very low risk — and that testing would be low yield?  If possible, could you quantify the concern I should have on a scale of 1 to 10?  The event occurred one week ago and, since I have to wait 30 days to test, would it make sense to receive a penicillin injection as a prophylaxis?  PS.  There was a passing moment of cunnilingus.

You expressed concern.  It is difficult to know what is going on if you do not feel you can get accurate information.  As I now understand it, this is an ongoing, casual relationship with a partner who may perform commercial sex work from time to time.  You are correct, condoms are highly protective for syphilis acquisition and acquisition of syphilis through unprotected oral sex is relatively uncommon.  Her likelihood of having syphilis is relatively low but as you point out, that she was called back to the doctor's office following having lab tests performed the day before is worrisome.  ---

Okay, thanks.  She said she talked to the doctor today, and he said no syphilis.  If I can add a bonus question, what dosage of. Doxy or Amoxy?  Please do not answer if I am overreaching.

Final response:---