[Question #9800] Syphilis scare
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28 months ago
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Hi there, thank you for your time. I regret to say that back in the middle of January I engaged a sexual relationship with another male. It was only oral both ways and that was it. I am a married male and my wife recently about 4 weeks ago said she noticed a small bump on the inside of her labia. She said it hurt to touch and was more of a circular bump. It never seemed to become an open wound or anything according to her but it has been there for 4 weeks. It is still there at the moment but said it feels more hard now to touch but doesn’t hurt. I have never seen a lesion on my penis or anything since my encounter in the middle of January but I am worried that I may have contracted it orally and gave it to her. I don’t remember any sores being in my mouth but I do get canker sores a lot and may not of thought anything about it. We have only engaged in having sex one time since this encounter and I believe I did go down on her for a very brief period of time. I would be almost 10 weeks post exposure if I was exposed at this time and have not had any secondary syphilis symptoms but I wanted to know your thoughts on it from you guys? Just curious what my risk is? I am very worried that I contracted something and passed it along to her. Thank you for your time.
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H. Hunter Handsfield, MD
28 months ago
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Welcome to the forum. Thanks for your question and your confidence in our services.
You are right to be concerned about syphilis: you seem to know that syphilis is rampant among men who have sex with men (MSM) in the US and most industrialized countries. Even so, at any point in time the large majority of MSM don't have transmissible syphilis, and although it can be transmitted by oral sex, the large majority of transmissions occur during anal sex. Therefore your numerical risk was small, and the chance you have syphilis is lower still because you've had no symptoms: the large majority of new infections after exposure of easily observed locations (like your penis or mouth) develop obvious chancres, i.e. the ulcerative lesion of primary syphilis.
Your description of your wife's labial lesion is consistent with a chancre that had not (yet?) ulcerated. That it still has not ulcerated argues against syphilis, and you don't mention sweiling in the groin, which occurs in most patient with genital chancres. On the other hand, most other genital inflammatory conditions would have resolved within 3-4 weeks. Therefore, I can't guarantee her lesion isn't syphilis. But considering all the available information, the chance either of you has it is extremely low.
The answer here is simple and quick: you need a syphilis blood test. Enough time has passed for a nearly conclusive negative result. The maximum time for test positivity has never been systematically studied, but almost all infected persons will test positive within the 8-9 week time since your January exposure. And a negative would be 100% proof that you could not have infected your wife. You could then have another test in mid-April (3 months after exposure) for conclusive confirmation.
Ideally, it would be reasonable to see a knowledgeable health care provider, but in this situation it would be OK to test directly with a local lab. It also would be reasonable to have a urine gonorrhea test, even though absence of abnormal penile discharge or painful urination is almost 100% proof against gonorrhea. And I would also recommend an HIV test as well, if only for additional reassurance: oral sex is extremely low risk for HIV, but you don't want to take unnecessary risks in regard to such a dangerous infection. You don't need any other tests aside from these. (To be clear, I do not recommend your wife be tested for syphilis or anything else until and unless you are found to be infected.)
I'd be happy to comment further if you'd like to let me know when your syphilis blood test result is known. In the meantime, I hope these comments are helpful; let me know if anything isn't clear.
HHH, MD
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28 months ago
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Thank you for the response. I plan on going in to get that done soon. There was no complaint of groin pain with anything either. The guy did say he gets tested every 90 days and didn’t have any rashes or lesions on him. Said he was tested late December. So I don’t know. I really hope it’s not the case. What is the time period for secondary syphilis symptoms?
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H. Hunter Handsfield, MD
28 months ago
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I trust soon means within a few days; you shouldn't wait longer.
Secondary syphilis manifestations -- generalized skin rash, often lymph node enlargements in various areas (usually most noticeable in groin, neck and armpits), fever, plus a hundred others less frequently -- typically begin soon after primary chancre resolves or 2-4 months after exposure. But don't go looking for them. Repeated prodding one's own groin, armpits, etc is a good way to cause misleading tenderness and swelling that don't mean anything but can be confused with lymph node involvement. Anyway, don't rely at all on symptoms. The blood test is more important.
Threads are closed after two follow-up exchanges, so you have one coming. I suggest holding off on further discussion until you have your test result.
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28 months ago
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I went ahead and have an appointment with a health care provider on Monday. One question in regards to HIV. If for some reason this guy had a lesion that I missed Im assuming that would increase the risk of oral transmission? I just wanted to ask. Also, is pink eye ever associated as a secondary syphilis symptom? I can purchase a new question once my results come in if you close this one.
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H. Hunter Handsfield, MD
28 months ago
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If you were exposed to an active syphilitic ulcer, it would have increased the chance of syphilis, but probably would have little effect on the likelihood of HIV infection.
Conjunctivitis (pink eye) is not a typical symptom of syphilis of any stage.
Assuming your blood test is negative, as expected, there will be no point in asking another question on the forum; we would do no more than symbolically nod in agreement that you don't have it. But I'll make a deal with you: in the event the test is positive and/or any other medical consequence of your exposure becomes apparent under your doctor's care, and you return with a new question about it, we'll reimburse your posting fee.
I hope the discussion has been helpful. Best wishes and stay safe.
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