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Expert Opinion on Syphilis Exposure Risk
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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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Expert Opinion on Syphilis Exposure Risk

Recently, I was diagnosed with stage one Syphilis.  I caught it very early before the chancre had even formed fully or became an ulcer.  I had not had sex with my girlfriend for about two weeks before the first indications of a chancre appeared (she was never exposed to any breaks in my skin).  In reading about Syphilis, it sounds like direct contact with the ulcer/chancre or a break in the skin is necessary for transmission to occur (at this stage).  My girlfriend does not have health insurance, and is concerned about paying for tests and treatment out of pocket.  We want to know if she is at truly serious risk of infection without ever having had any contact at all with the chancre while it was running it's course.  Can syphilis be transmitted any other way at this stage (excluding other open wounds, etc.)?  Basically, if the risk is extremely low or non-existent, she doesn't want to have to save the cash to pay for the medical testing.  I'm due to get an injection of Penicillin today.

Thanks!
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Welcome to the STD forum.

As you seem to know, your presentation was atypical, and it is quite difficult to diagnose primary syphilis before a chancre even forms.  I could give you better advice if you will describe the details of your symptoms and how the diagnosis of syphilis was made.  Also, tell me something about yourself and your partner, and the nature of the sexual exposure at which you caught syphilis.

Assuming you indeed have syphilis:  If you haven't had sex with your girlfriend since the exposure where you caught syphilis, then she is not at risk and she doesn't need either testing or treatment.  Syphilis cannot be transmitted except by direct, intimate contact with an infectious lesion.

But if you had sex with her since then, even once, she should be both tested for syphilis and treated. It is correct that transmission risk rarely occurs before an open chancre is present, but this is not hard and fast and syphilis is too dangerous a disease to take chances.  Standard policy is that she be treated, as long as you had sex with her any time after the sexual exposure that infected you until the time you are treated.  And everyone treated for syphilis should also have a blood test, to confirm that she wasn't infected against of time.  If she isn't tested and someday has a positive syphilis test, it will be impossible to know when she was infected or whether treatment failed.

So please do what's right for her health.  If you're in the US, your local health department probably will both test and treat her at no charge.

Finally, you should talk to the health department -- if that hasn't been done yet -- to assure that your other parnter (from whom you were infected) and his or her other partners all are tested and treated.

If you'll provide the missing information at the opening of my reply, I may have further comments.

Regards--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
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