[Question #9785] Treatment

29 months ago

Hi Experts.

Had an M2M oral encounter (received and briefly gave) almost 72 hours ago from someone I met online.

I am very worried about having acquired gonorrhea, chlamydia, or syphilis.

I received a 500mg intramuscular injection of ceftraxione a little over 48 hours after the encounter.

What does this do for the chances of acquiring each of the above infections? When should I test next? Apologies for any redundancy across the forum.

H. Hunter Handsfield, MD

29 months ago

Welcome back, but I really don't understand the reason. You ask nothing here that wasn't covered in your just-closed thread. As we discussed, you were at zero risk for chlamydia, minimal risk for syphilis, and only slight risk for gonorrhea; and having had ceftriaxone, any chance of gonorrhea or syphilis has now been eliminated.

If you were hoping for Dr. Hook's perspective, it was pointless. Although our writing styles are each our own, we have been close colleagues for nearly four decades and our expertise is identical; there is never any signfiicant difference in our professional evaluations, opinions, or advice. I can assure you he would agree exactly with everything I have said in your previous thread and this one.

All is well. Do your best to accept and believe the reasoned, science based reassurance I have tried to give. Best wishes.

HHH, MD

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28 months ago

I'm sorry to be back with a response ... this will help my peace of mind, which I have mostly achieved

With ceftriaxone and syphilis: I was reading about it and I couldn't find agreement on dosage amounts, but they all seemed to be really high and re-administered daily, but these studies were after people had been diagnosed. Is the reason this 500mg injection is effective at aborting an incubating infection because its being administered so soon after the exposure, and the rate at which syphilis spreads in the body is so slow, so a miniscule amount of the antibiotic will work? haven't seen this elsewhere on the forum, so i hope its interesting info for people.

I saw you and Dr. Hook did a study on ceftriaxone and syphilis, which also reassured me! Besides ur evident expertise.

Thanks for being so responsive. I got a test at day 6 just to ease my chlamydia worry. And understanding this will close the loop on syphilis.

I am not worried about gonnorhea! which i recognize would be completely illogical.

H. Hunter Handsfield, MD

28 months ago

It is apparent that you are mostly seeing discussions of ceftriaxone for treatment of established syphilis. For prevention after exposure, a single 500 mg dose is 100% effective in preventing the infection from taking hold if given before a chancre appears, or if given within 10 days after the exposure. 500 mg is not a "minuscule amount": it provides blood and tissue levels of ceftriaxone hundreds of times higher than the levels needed to kill Treponema pallidum; in fact hundreds of times higher than the levels of penicillin achieved with benzathine penicillin, the standard treatment of established syphilis. Having had that treatment, you should not even have a syphilis blood test: there is no possibility of a positive result.---
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28 months ago

Hi Dr. Handsfield,

Had burning and discharge at day 10. Chlamydia test came back negative, so I was given 100mg doxycycline 2x daily for 7 days for suspected NGU.

Symptoms cleared up within 2 days. Completing the course today.

Had ceftriaxone somehow not aborted syphilis, would this dosage of doxycycline have done so if I began 10 days after the event?

Feeling a lot less worried and planning to resume sex with my partner.

Appreciate you & the forum.

H. Hunter Handsfield, MD

28 months ago

Sorry to hear that the event resulted in NGU, but glad to see you were treated correctly. And that you'll be back in the game with your partner.

Doxycycline for a week definitely aborts incubating syphilis, as long as started before onset of a chancre (syphilitic sore); no worries there.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the two discussions have been helpful. Bet wishes and stay safe.

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