Clarithromycin and Syphilis/Gonorrhea

[bobbopcr]

Dear Dr.,

I've read a great deal of your posts and want to say thank you for curbing my anxiety.

In brief:  I received and gave oral sex with a female CSW about a week ago.  The entire exchange took no longer than 40 seconds in both cases, after which we stopped.  I did not engage in any other kinds of sexual activities with her.

I know from reading that my only bacterial risks are gonorrhea and syphilis.

3 Questions:

1)  Given that oral syphilis is rare, and syphilis in general is rare, can you give me any idea of the odds of my having come into contact with a CSW with syphilis (I live in Germany)?

2)  Due to a sinus infection, I have been taking 2 X 500 mg of Biaxin / day for the past four days, the prescription is for a total of 7 days.  I started taking this 2 days after the event.  Can you tell me whether this would cure potentially incubating Syphilis and Gonorrhea?

3)  In some of your posts, you have mentioned "If I were you, I would do this..." etc.  I am married - this experience was a drunken mistake and nothing more - and I am wondering, in light of potential infection, medication efficacy and lack of any symptoms, when I can start having sex with my wife again?

Thanks for your time Doctor

[Edward W Hook, MD]

No, the CRP would be normal in persons with incubating syphilis.  Furthermore, the CRP is a non-specific indicator of inflammation so if yours is elevated, the next task would be to try to figure out why

EWH

[bobbopcr]

Dear Dr. Hook,

Thank you, you are a kind man.  What may have seemed like a waste of your time (my sincerest apologies) was not a waste to me.  Now I can get on with my life.

Maybe I can offer you some insight into perhaps why people get so concerned over testing dates for syphilis:  one hears everywhere that syphilis can take 10-90 days to show symptoms, so it's difficult to wrap one's mind around a 6 week testing period being ok.  I think that may be where a lot of the concern is coming from, from other posters on this site (it was also my concern).

No more questions:  thank you again, and may you be well.  You have done more for me than you can imagine.

[Edward W Hook, MD]

Plese believe your test results.  End of discussion.  EWH

[bobbopcr]

Dear Dr. Hook,

I know I have been warned, and if I could just get an answer to a question I will never open this site again.  I realize that I have a mental health issue, I am taking medication and seeing a therapist.

Recently I developed a red bump on my upper lip near the corner that has not erupted into a lesion or anything.  My concern is that all of the antibiotics I have taken may have delayed the onset of syphilis.  I took a TPPA test at 40 days and it was non-reactive.  Now I am at 61 days.  Would you say that I can view this test as 100% conclusive?

I appreciate it and will bother you no longer.

[bobbopcr]

Dear Doctor Hook,

Thank you for taking the time to answer my many questions.  I will have no further ones.  You are correct regarding the guilt.  I have made an appointment to see a counselor.

Have a nice weekend.

[Edward W Hook, MD]

You need to get over this.  I suspect your questions come from guilt more than anything else.

Doxycycline is highly effective for syphilis and would also prevent/cure syphilis if you had been exposed.

Syphilis is transmitted when lesions are present.  You would know if you had a lesion.  You wife is not at risk.

Time for this threat to end.  EWH

[bobbopcr]

Dear Doctor,

I don't mean to be annoying, but like most of the posters here I am a bit nervous right now.  If necessary I can pay for another thread.

2 more (final) questions:

1)  Currently my doctor has switched me over to doxycycline, 300 mg/day for 10 days because my sinus infection didn't respond to the clarithromycin as well as hoped.  Would this dosage prevent/cure a syphilis infection, if it were present?

2)  In the one in a trillion chance that the clarithro didn't clear up the one-in-a-million-chance of a syphilis infection, and it had been incubating, could I have passed it on to my wife during intercourse (no symptoms whatsoever) prior to switching over to the doxycycline?

Thanks and no more questions.

[bobbopcr]

Dear Doctor,

I hope I'm not overstepping any boundaries at this point.  If I do, I apologize and I promise this will be my last post in the matter:

Would a CRP Blood Level show an irregularity with incubating Syphilis, that is in my case 18 days after a possible exposure?

Thank you Doctor, and again, my last post.

[Edward W Hook, MD]

Unless it is for the puprose of relieving your anxiety, I see little advantage to you to testing in the absence of symptoms.  EWH

[bobbopcr]

Dear Doctor,

I hope that I can ask one more question:  assuming I don't develop any symptoms, do I need to do any testing from a medical standpoint?  I understand some people choose to do testing if they develop too much anxiety about their situation, but would it be necessary medically in my case?

Thank you Doctor

[bobbopcr]

Dear Doctor,

Thank you for your answer.  It helps a great deal to alleviate my worries, and I will come back to it whenever I'm feeling anxious about the issue.

It is a great service that you provide.  Thank you once again.

[Edward W Hook, MD]

Welcome to the Forum.  I will try to address your questions however it is also important for me to point out that the questions are asking for probabilities and as such, if something occurs once out of a million times and you are the one, the other 999,999 people don't matter, do they.  Thus there is no real was to say "for sure" or make recommendations with absolute certainty.  I hope my comments will help you to sort out your own risks:

1.  I do not know the syphilis rates in Germany but here in the US, 1 in 10,000 people have syphilis and syphilis is transmitted by direct contact.  Less than half of potentially infectious contacts result in transmission of infection.  Assuming that you did not see an oral lesion on your partner, the risk of syphilis has to be miniscule and really is not something to worry about.

2.  Clarithromycin has not been studied for gonorrhea treatment however it is likely to be active and effective in many cases.  That you are taking clarithro for 7 days makes it even less likely that you have gonorrhea or will develop syphilis.

3.  From what you have told me, I would not hesitate to have sex at this time.  the chance that you have anything and thus, the chance that you would transmit anything is close to zero.

Hope this helps.  EWH