Concerned about Syphillis/other infections

[wtwall]

On April 14th of 2006, I gave oral sex to another male, unprotected, w/o ejaculation.  I saw my PCP six months later to have an HIV test ran.  This doctor had been my (and my family's) doctor since I was age 8 and I just couldn't bring myself to tell him about my sexual contact with another male, so I told him I'd had sex with an ex-girlfriend unprotected.  The HIV test came back negative.  He asked me some questions when I told him about the contact and then said that the only test he felt needed ran was the HIV one.  I'm pretty sure if I'd of told him that I'd had contact with a male, he would of ordered a Syphillis test too.

Do I have cause for concern here?  My old doc had asked me if I'd had any symptoms since the contact when he ordered the HIV test.  I haven't.  I get canker sores on and off with stress in my mouth, so I could of easily missed a chancre from syphillis.  I never got a rash or anything, but I did come down with a nasty respiratory infection that was diagnosed as Pneaumonia in May of 2006.  I was treated then initially with Azithromyacin 250 mg for seven days (I took the standard loading dose of 500 at the beginning).  That didn't kick it so my doctor had me take Cefaclor 500 mg four times daily for I believe five days.  I had a case of sinusitis in February that was again treated with Cefaclor 500mg, but I can't remember the dosage/duration.

I also take Cephalexin 500 mg once daily for acne, prescribed by my dermatologist.  I've been taking that for several years now, both before, during and after the sexual contact above.  Does that make any difference?  And most importantly, I've read conflicting tales on the internet -- what kind of test will be necessary to diagnose this?  Will a simple blood test reveal it or will I need to have a lumbar puncture?  I'm very scared of the idea of a lumbar...I know they are very painful.  Any other tests I should have ran?

John

[H. Hunter Handsfield, M.D.]

Although syphilis indeed is epidemic in gay men in the US and other industrialized countries, at any point in time fewer than 1 in several hundred are infected.  And the chance of catching syphilis during any particular episode of sex--especially performing fellatio--is very low, especially if you noticed no sores on his penis.  Further, the cephalexin indeed is 100% protection against syphilis if you were exposed; and the dose of azithromycin you were given, and probably the cefaclor as well, would cure it.

So there is no way you have syphilis and there is no point in having a blood test. And you certainly don't need a lumbar puncture.  Where did you get that idea???  (For what it's worth, a properly done LP isn't as painful as you describe.  Of course not something to do for hoots, but overall stress and pain are comparable to the average dental visit.)

Finally, you need to make up your mind either to tell your doc about your lifestyle, or find a provider with whom you can be comfortable about it.

Good luck--  HHH, MD

[wtwall]

I had read on a couple of websites that, if the time period of exposure to syphillis is uncertain and possibly more then a year, that a lumbar would be needed to r/o neurosyphillis and that the blood test might not be accurate.  To be honest, I thought that was a little fishy...but I figured talking to someone with actual knowledge in this area would confirm or deny that.  :)

Thanks for the prompt reply.  And you're definetly right.  I'm due for a physical anyway (need my lipids ran again), so I think I'll just be honest with him then.  I really don't have anything to lose.

[monkeyflower]

"For what it's worth, a properly done LP isn't as painful as you describe."

Unless you're House, that is--the 8th time's the charm! God, I love that show.