Question about Syphillis

[CuriousAboutAll]

Hi Doctors,

I'm not sure if I'm asking in the right forum...

I was tested for syphillis at 30 days after a sexual encounter with a girl by VDRL and FTA-ABS tests and both resuts were non reactive. I didn't have any visible lesions of any kind.

Do I need a retest or are the results conclusive ?

My contact was protected penetration but unprotected oral sex.

Thanks again !

[CuriousAboutAll]

Just one more question. About the lesions (pimary), in how many days they appear in case of contamination ? Could they appear for example after 70 day after the supposed contamination ?

Thanks !

[H. Hunter Handsfield, M.D.]

You "forgot" you took azithromycin?  I have trouble believing that.  It is more plausible that you withheld it because you thought it would influence my reply in a way that for some reason you wouldn't like as much.

Almost would have aborted syphilis if you were exposed, in which case you would never develop a positive test.  Some strains are resistant to azithromycin, so feel free to have another test at the 6 week mark if you want still further (but in my view unnecessary) reassurance.

This thread is over.

[CuriousAboutAll]

Wow... I just remember something that could be important...Sorry but I remembered just now. Really ashamed about this. I shouldn' t be asking you about this again :(

Some days after the encounter, I don't rememer exactly, maybe 5 days, I went paranoid and did something I shouldn't... I took 2g of Azithromycin and repeated again 1 week later and the VDRL/FTA test was done at day 29.

Do you think this could ruined the test ?

[CuriousAboutAll]

Thanks again. Nothing to worry about it was just curiosity.

[H. Hunter Handsfield, M.D.]

A chancre usually appears 10 days to 3 weeks after exposure, rarely 4-5 weeks.  70 days is much too long.

[CuriousAboutAll]

Dr. HHH,

Thanks for the patience and a very direct and clear answer.

Kind Regards !

[H. Hunter Handsfield, M.D.]

When syphilis occurs without a visible chancre, it is because the chancre is hidden, e.g. in the anus or vagina.  If the exposed site is readily visible, a chancre probably is always apparent.

So I think you can safely consider this a closed issue.  The combination of a safe (condom protected) exposure, plus no chancre, plus negative blood tests (even if a little early) amounts to complete certainty you didn't catch syphilis.

[CuriousAboutAll]

Hi Doctor Handsfield

First of all, thank you for your answer. I´m starting to really like this forum and the way you run it. You´re doing a really great job here.

I decided to ask you this because I read somewhere that some people won´t develop a chancre and I was a bit concerned about this. Now there are about 70 days from the contact. As I told, It was oral sex and if I understood well, the lesion would appear in tongue/mouth/penis, and until this time no signs of it, just some occasonal itching in my hands, that I suppose to be related with other causes because of the lack of lesions.

Would you recommend a new test or may I consider it a closed case ?

[H. Hunter Handsfield, M.D.]

The risk of syphilis from this exposure was just about as low as for HIV, i.e. nearly zero as discussed in your other thread.  And if you had been infected, by now you would have had a chancre (open sore) at the exposed site where syphilis was acquired.  However, the lab tests you have had are not quite conclusive; you need to wait 6 weeks for definitive syphilis testing.  If you have a repeat test, however, you can definitely expect it to remain negative.  You need not return to let us know the result.

HHH, MD