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STDs (Expert Forum)
transmission during incubation
Answered by
University of Washington
Seattle - WA
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This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
transmission during incubation
by scared_83, Mar 04, 2007 12:00AM
While in SE Asia protected vaginal sex (No kissing) w/ sex worker. Cndm possibly broke, looked empty pulling out. Worried about passing Syph to wife thru blood in incubation period.•1 wk b4 & 1 wk after exposure, took 1-2 Avelox for unrelated inf.•4 wks after exposure came home to wife Deep kissing only. •8-9 days after kiss she had mouth sore inside cheek & swollen face, subsided over days, sore lasted 1.5 wks,(did not see it).•4 wks after her sore started she went to Arizona a rash started on parts of body(didn't see it), then started going away. She has eczema but not this bad fora few years. At 11 wk after ELISA test took Flagyl for trich, not knowing 2g can kill Inc Syph. Now worried I ended window period for future testing not knowing if I already infected her. My tests:•RPR at 9 wk mark NEG •ELISA test at 11 wk mark NEG.•FTA-ABS test at 12 wks(Flagy 1 wk prior) NEG 1.At 4 wk mark could I have infected my wife thru kissing? cuts or sores that we didn’t see (blood after brushing teeth)? Coincidence?(canker sore & drier climate in AZ compared to CT?)she never had a rash that bad b4 over there. 2.At 12 wk is NEG FTA-ABS still valid after Flagyl? 3.Is Syph blood infectious enough in the Inc. stage & transmissible where any of tests would miss & what affects the accuracy tests at different times after exposure? WebMD says the FTA-ABS test can detect except during 3-4 wks from exp, some say 13 wks. Antibiotics delaying prim stage? Can rely on the test results at 9 & 11 wks & keep quiet. I never saw any sores near my genitals only a mouth sore at 10 weeks near gums.
Doctor's Answer
by H. Hunter Handsfield, M.D., Mar 04, 2007 12:00AM
, Mar 04, 2007 12:00AM
Most of your question is irrelevant because of the biology of syphilis. The organism does not get into the blood until well into the primary stage of syphilis, the chancre. It is not there during the incubation period, and transmission does not occur by any route (sexual, blood, kissing, or anything else) during the incubation period.
Your story of not knowing whether or not the condom broke is not credible. If it broke you would know it for sure. In any case, your compulsively repeated negative tests prove you don't have syphilis. The antibiotics you had would not affect the test results. Your wife's oral sore is something aside from syphilis.
Don't I recognize your username as associated with previous anxiety-driven threads here or on the HIV Forum? (Search function not working properly and I can't check it out.) Apologies if I'm wrong, but the tone of this message suggests a similar level of unreasoned anxiety.
HHH, MD
Your story of not knowing whether or not the condom broke is not credible. If it broke you would know it for sure. In any case, your compulsively repeated negative tests prove you don't have syphilis. The antibiotics you had would not affect the test results. Your wife's oral sore is something aside from syphilis.
Don't I recognize your username as associated with previous anxiety-driven threads here or on the HIV Forum? (Search function not working properly and I can't check it out.) Apologies if I'm wrong, but the tone of this message suggests a similar level of unreasoned anxiety.
HHH, MD
My worst fear is that if I ever did have it in incubation and passed it on to her and somehow cured myself with the 2g Metronidazole inadvertandly (info from British Medical Journal 1967), that I would be leaving her behind with Syphilis and in the dark never knowing since she would not test for it unless I told her which would definitely be disastrous.
I was just confused with the incubation period as I have read in a few places including Merck Online manuals that "within hours it enters the body then reaches lymph nodes then spreads in the bloodstream". You stated that it isn't in the bloodstream until well into primary stage. I just wanted to understand how the incubation period works so I can eliminate the last item on the list of Stds I am worrying about and get back to normal again. I see that logically either I never had Syphilis or had a long window period that couldve passed it on through kissing at week 4 which is most unlikely since:
Original encounter was Condom protected vaginal sex (no oral sex, no kissing)
Worried about infecting wife through deep kissing which is away from site of initial exposure (after brushing teeth though possible blood or cut lips)
Did not see a sore on me (couldve been missed alot of pubic hair)
9 week RPR Non-Reactive
11wk ELISA Non-Reactive
12wk FTA-ABS Non-Reactive (1 week after Metronidazole)
The hardest part of this whole thing is that even though very unlikely or close to impossible, her symptoms seemed to fit exactly within the time frame for description of Primary and Secondary Syphilis (sore in mouth & swollen face 1 week after kissing then body rash 4 weeks after that) and I would like to totally rule out Syphilis as a possible cause. I am concerned about the fact that I couldve ended the window period at 11 weeks and not finished the entire 13 weeks. Can you shed some light on what factors or percentage of people would take up to 13 weeks. I feel fairly confident that if I had ever progressed to primary stage that the tests would be accurate enough to detect it at 11 weeks, I am young 31 and otherwise healthy the only thing that I did notice was a painless sore on my inside gums 5-6 days before the 11 week test that seemed to might have been oozing fluid although that went away in a week. I feel fine now and have no problem checking myself to see if I have anything but my only concern is that of the 4 week mark of passing it through deep kissing leaving her potentially suffering with my problem.
Forgive me for being redundant as I just want to make sure I understand and am clear on this, as I have to make the biggest decision of my life to tell or not tell which telling would have very drastic consequences. I love her very much want to do the right thing and not hurt her in any way. I would much rather not disclose what happened if I know for sure that this scenario is not technically possible. Thank you once again for your help your professional advice is greatly appreciate.
p.s. this is the 1st post I have done, perhaps there is someone w/ a similar name.
HHH, MD
I apologize for the long comment I just want to clarify a few things that I may be misunderstanding. I would appreciate any assistance you can give me in answering a few technical questions that I cannot seem to find answers for elsewhere. In the end I just want to rule out as much as I can in addition to the Negative test results and find out in my particular scenario what is even techinically possible. I do greatly appreciate your help and value your expert opinion so I will keep it brief.
1. In my case original exposure to vaginal sex then me transmitting by kissing, if a cankersore/cut were in my mouth is that even possible to transmit or would I specifically have to have a syphilis chancre?
2. How significant is the level of detection between 11 and 13 weeks for ELISA, FTA-ABS tests?
3. Merck Online manuals that "within hours it enters the body then reaches lymph nodes then spreads throughout the body by way of the bloodstream". http://www.merck.com/mmhe/sec17/ch200/ch200b.html You stated that it isn't in the bloodstream until well into primary stage. Can you clarify if this is a discrepancy or am I misunderstanding how this works?
Thank you very much once again.
Your compulsive concern about syphilis seems quite unreasoned. The negative tests you have had PROVE you do not and cannot have syphilis. Thus all your other questions are irrelevant.
You are correct in pointing out my error in the theoretical possibility of syhphlis organisms being in the blood in early infection. But there has never been a documented case of transmission through blood exposure during the incubating stage, and it obviously is irrelevant to your situation.
This thread is over. I will not respond further.
HHH, MD