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Oral Sex and 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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Oral Sex and Syphilis

I am a gay man who gave oral to a guy in a discreet hook up off of craigslist over 3 months ago.  I sucked him to completion but did not swallow nor did he *** in my mouth. About 6 weeks ago, I developed a salmon oval shaped spot on my abdomen that was solo for about 1-2 weeks and recently (about 3-4 weeks ago) I developed a skin rash over my trunk (chest, abs, lower back, upper thighs - there is no involvement on the palms or soles of my feet).  A visit to the dermatologist confirmed  pityriasis rosea rash and the dermatologist said it was a "classic" presentation of pityriasis rosea.  I never had a chancre in my mouth, never had a fever, lymph node involvement and my partner has had no symptoms and we are very sexually active with each other (oral sex > 3 times per week, anal sex around 1-2 times per week).  I am petrified this could be syphilis despite what my dermatologist has said and the fact that I have read that it is rare (some say very rare) to get syphilis from oral sex.  Am I over worried about this and should I have complete confidence in the diagnosis of pityriasis rosea?
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239123_tn?1267651214
Welcome to the forum.

In general, anonymous sex between men is pretty high risk for syphilis.  However, the evidence is overwhelming that's not what you have.  1) Although oral-genital syphilis transmission can occur, it isn't very common.  2) If you had caught syphilis, the initial sign would be an open sore of a directly exposed area -- in this case your penis or mouth.  3) A dermatologist's diagnosis of pyityriasis rosea is highly accurate.  Although PR can be confused with secondary syphilis, few dermatologists would confuse them.  4) It is only the rash of secondary syphilis that is sometimes confused with PR, and secondary syphilis does not occur sooner than 3 months after exposure.

If you want further reassurance, you can always have a syphilis blood test; the test is accurate any time 6 weeks or more after exposure.  But I really don't think it is necessary; you can definitely rely on the dermatologist's diagnosis.

I hope this helps. Best wishes--  HHH, MD
4 Comments
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Avatar_m_tn
I should add that I have never had any unprotected anal sex and I do not frequently meet guys for discreet encounters. Last discreet encounter was January 2011 and March 2011.
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239123_tn?1267651214
I saw this before replying.  It makes no difference in my opinion or advice.
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Avatar_m_tn
Thank you very much!  I fully understand and appreciate that anonymous gay sex is risky and I can assure you that it will never happen again.  Although petrifying, it was a valuable lesson learned.  Thanks again for your insight.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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