I am planning on getting a VDRL test done in a few days and I would like to know how anxious I should be. Should I also be re-tested for Chlamydia and gonorrhoea?

Welcome back to the forum. I reviewed your discussion with Dr. Hook nearly a year ago, which was related to the same exposure you remain concerned about. I agree with all he advised, although it seems you had not yet had STD testing until afterward.

First, gonorrhea and chlamydia:  Your test results 5-6 days after the exposure were conclusive. You weren't at risk for chlamydia anyway; oral chlamydial infection is rare and, when present, the numbers of organisms is very low, so that urethral infection is extremely rare after an oral exposure. Regardless of that, the tests for both organisms are extremely accurate. Further, in the very unlikely possibility you had asymptomatic infection with either one, the immune system clears urethral gonorrhea or chlamydia within a few weeks, a few months at most. There has never been a documented infection that persisted 10+ months. There is no point in retesting for them at this time.

As for syphilis:  You are correct that testing 5-6 days after exposure is meaningless; it takes at least 2-3 weeks and up to 6 weeks for positive blood test results. In both this question and your previous one, you (pointedly?) seem to avoid mentioning your partner's sex. If female, the chance she had syphilis was low, regardless of the number of male partners she had. If male, syphilis was a significant risk; in the US and other industrialized countries, syphilis is rampantly epidemic in men who have sex with men, especially those with multiple anonymous partners. On the other hand, the chance you have syphilis is low.

First, syphilis is not commonly transmitted by oral sex. It certainly can happen, but oral accounts for a small proportion of transmissions compared with anal and vaginal intercourse. Second, you would be unlikely to miss the symptoms if you were infected. Unrecognized primary infection can occur, but mostly because the exposed site is not easily observed (e.g. inoculation inside the vagina or rectum). But you obviously would have noticed a typical chancre of your penis:  a fairly large (¼" - ½") open sore lasting at least 10 days and up to a month; plus tender swellings in the groin due to inflamed lymph nodes.

That said, asymptomatic primary syphilis is possible and you are exactly right to have a syphilis blood test. It doesn't need to be the VDRL test; RPR or an EIA test would be equally fine, and these are done more commonly than VDRL as the initial test by most labs. A negative result with any of these is equally conclusive. And that's definitely what you can expect, negative -- so stay mellow while you wait for the result. I'll be very surprised if you have syphilis.

There's another lesson here:  condoms! Please keep them handing and use them in event of future events like the one eleven months ago. (You're probably told yourself the same thing many times!)

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

HHH, MD

Points to clarify, the tests offered locally to me are the Unigold HIV rapid test for which I was negative and the VDRL test. I am unsure if any others are offered if there is a positive VDRL. Are these tests sufficient in these circumstances?

Those tests are perfect; the negative results are conclusive.

Either of two types of test is used for initial syphilis screening:  the "nontreponemal" tests like VDRL and RPR; and T. pallidum-specific antibody tests by enzyme immunoassay (EIA). All are equally accurate and 100% effective in ruling out syphilis if done 6 weeks or more after the last possible exposure (usually positive by 4-5 weeks, always by 6 wk). If and when you need testing for syphilis in the future, whatever test is routine in the lab will be just fine. If negative 6 weeks or more after exposure, you're done. If positive, all labs routinely reflex to a confirmatory test, of which there are several types. These all are pretty much equivalent to one another. Syphilis is not diagnosed unless both the screening and confirmatory tests are positive.

I cannot quantify your syphilis risk more than I did above. Unlike other STDs (HIV, HSV, gonorrhea) there are no quantitative data about per-exposure transmission risk. But clearly the number of new syphilis cases annually in any jurisdiction is tiny in comparison with the total number of sexual exposures between infected and uninfected persons. In other words, the risk always is numerically low for any particular event -- and as implied above, especially low for oral-genital exposures. Sorry I can't be more precise.

That concludes this thread. Best wishes and stay safe.