STDs Expert Forum
CONCERNED ABOUT SYPHILIS
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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CONCERNED ABOUT SYPHILIS

I am a 31 year old New Zealander. 8 weeks ago, I had an encounter with a 39 year old white woman. She was not a sex worker but is likely promiscuous. I had protected vaginal and unprotected oral.

Tests summary:
9 days post exposure: chlamydia/gonnorhea
18 days: chlam/gonn, syphilis
32 days : took 1 g azithromycin
45 days: chlam/gonn, HIV, Syphilis
52 days: HIV, Syphilis (EIA, VDRL)
All tests were negative

I got contacted by the lady 4 weeks after - she tested positive for chlamydia. I went to the Dr and he said to take 1g of Azithromycin just to be sure. I had this medication 32 days after exposure.

At 51 days after, I noticed a very small (3mm) red sore with a crack through the middle on the shaft of my penis not far below the head on the underside. I panicked, and went back to my Dr. He said it looked nothing like a chancre - mine felt quite soft and lacking substance. He did however test my for syphilis again using EIA and VDRL tests (52 days). These came back negative.

I went to sexual health where I was seen by a doctor. I asked her to do dark field microscopy. She said my tests were reliable and that it wasn't likely to be a chancre but could be a herpes lesion instead. She informed me that because there was nothing to squeeze, it would be hard to do microscopy on the material anyway. My "sore" has largely gone away although the skin is still pink. It lasted 5 days. My questions are as follows:

1) What was my risk of contracting syphilis from unprotected oral and protected vaginal?
2) Does my sore sound like Syphilis to you?
3) Is my testing regime reliable?
4) Would taking 1g azithromycin at 32 days post exposure affect the accuracy of my syphilis test at 52 days?
5) Is getting a primary chancre at 7 weeks common?
6) If it was a  primary chancre, would this not mean the tests would take longer to become accurate.
7) Are further tests warranted?
300980_tn?1194933000
Welcome to our Forum.  Your risk of syphilis from any single encounter is low.  In New Zealand syphilis is rare and only about 20% of syphilis in New Zealand occurs in women with most infections occurring in men who have sex with other men.  The lesions you describe do not sound like syphilis. Finally, had you been exposed to syphilis, it is highly likely that the azithromycin you took would have prevented syphilis for occurring. Finally, your blood tests at 18, 45, and 52 days rule out the possiblity of syphilis.  Thus, putting all of these together, I can assure you that the lesion you noticed was not syphilis.

In answer to your specific questions:
1) What was my risk of contracting syphilis from unprotected oral and protected vaginal?
Low, not only is it unlikely your partner had syphilis but the risk of syphilis from either protected genital or unprotected oral sex is virtually zero.

2) Does my sore sound like Syphilis to you?
Not at all.

3) Is my testing regime reliable?
Yes, it proves you did/do not have syphilis.

4) Would taking 1g azithromycin at 32 days post exposure affect the accuracy of my syphilis test at 52 days?
The azithro would prevent syphilis, had you been exposed.

5) Is getting a primary chancre at 7 weeks common?
No, it is nearly unheard of.

6) If it was a  primary chancre, would this not mean the tests would take longer to become accurate.
It was not syphilis and had it been, your test would have been positive.

7) Are further tests warranted? .
No, you need to stop worrying and move on.  

Take care.  EWH
5 Comments
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Avatar_m_tn
Thanks for taking the time to provide such a comprehensive answer. I have a couple more questions arising from your answers:

1) I have heard that azithromycin is far from a sure thing when used for syphilis. If that is the case, is it not likely that it may have failed to clear it up and invalidated the tests done for a few weeks afterward?

2) Is a dark field microscopy really that hard to do. She (the Dr) said that the sore didn't have enough substance to it to test properly - should I insist it does get done for my peace of mind?

Thank you again.
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300980_tn?1194933000
1. There are concerns about azithromycin for syphilis however this is irrelevant to you.  Your blood tests prove that you did not get syphilis.  If you had, AND you failed therapy (both of which are unlikely) your test would have been positve.

2.  Darkfield microscopes are not widely available (they are different from more typical, light microscopes) and relatively few people know how to do the test well.  Again, believe your test results.  

You need to put your syphilis fears aside.  To continue to worry makes no sense whatsoever.  EWH
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Avatar_m_tn
Great. Thanks for humouring me. I guess one of the issues in my head is there are so many different statements out there about the window period. Three months is commonly mentioned.

1)Do you have a percentage for how relaible my EIA & VDRL tests are?

2) Which test is themost accurate?

These are my final two questions. Thanks for your kind help.
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300980_tn?1194933000
This will be my final answer.  Your paranoia is leading you to ask irrelevant questions.  When the two test results are considered together there there is no chance you acquired syphilis from the encounter you have described.

End of thread.  EWH
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