Oral and Syphilis

Hello,

I received oral sex from a CSW overseas twice now I am alittle concerned.  It was back in Nov '07.  I was tested for HIV and a urine sample for gonerea and clymydia but was not tested for syphilis or Herpes.  My doctor said oral is not really risky for syphilis and without sores he does not recommend a test for herpes...now to my questions...

1)  I sometime get small cuts on my foreskin from either rough masterbating (masturbating) or handjobs..I recall having a couple way before my risk but of course now I am reflecting thinking...I recall these to be small and sting like hell when I masterbate.  Is the Syphilis sore usually like the ones on the internet like the CDC website ro do they vary quite a bit.  The ones on the internet look quite obvious and something a man would not miss on his penis.

2)  Is is common to have them on the foreskin??  or are they usually on the actual head of the penis?

3)  I have read a bit about the infectiousness of Syphilis but I am alittle confused about one thing...if the chancre occurs within 6 weeks then secondary syphilis start after this is done and there are no more rash or sores how can you pass it to someone else?..or are you not infectious anymore??

4)  Do most people get the chancre and the rash? or do some just have one or the other??

5)  your patients that have had syphilis have they presented with typical symptoms??

6)  Although it is possible to get STD's from oral is it common to get syphilis through oral..how often have you seen it personly?

Thank you

[Edward W Hook, MD]

My goodness. it has been more than a year and a half since your exposure.  At this time you should have no lingering concerns about STDs.  I will do my best to relieve you concerns.  In doing so, I expect that I will be repeating much of what you have already heard from your doctor.  

In considering syphilis, let me first re-affirm what your doctor ahs said.  Syphilis IS rare among STDs and is transmitted by direct lesion contact.  In you did not see a sore on the CSW's mouth at the time of your exposure, you have little to worry about.  Getting syphilis is very, very rare.  Now, let's work through your questions:

1.  Syphilis sores (chancres) are typically quite obvious and are painless. The sores you describe sound far more like trauma from masturbation.

2.  They can be any site of exposure.  Thus chancres can appear on the head of the penis or the foreskin.  When they do, they are typically quite obvious.  

3.  Syphilis is only transmitted in the primary or secondary stages, when lesions are present. When lesions are not present, persons with syphilis are not infectious to others.

4.  Yes, most people do get a chancre, then the rash

5.  Yes

6.  I have seen it but I have seen more syphilis than 99.9% of physicians.  Oral syphilis is very, very rare.

Bottom line. the chance you got syphilis from the exposure you mention is miniscule.  On the other hand, it it is still on your mind, I would recommend that you go get a syphilis blood test, committing before you do to believe in the negative result I am confident you will get.  EWH

[justchecking180]

Thanks a bunch I feel a whole lot better...my doctor just seems to to think I am wierd about my concerns!...but as you have mentioned you are the expert my doc is not.  I understand it is rare but I was in Asia during this event...I forgot to mention this

You mention that a person is infectious when they have primary or secondary infection..what is the time frame on this??...and with secondary is this when a person has a rash do they also have sores during this phase?..

This will be my final question so I will thank you now..thank for your service

[justchecking180]

I forgot one question..

Would a CBC show something was wrong if one was infected with syphilis?

[Edward W Hook, MD]

Thgere are no clues to the presence or absence of syphilis on a CBC.

In secondary syphilis a rash it often present.  ABout 15-20% of persons with secondary syphilis also have chancres present at he time they are diagnosed.  Secondary syphilis typically resolves about 6 months following acquistion of infection.

I will take you at your word that these were your last questions.  If you have continuing concerns (which in my mind are not justified), then I would suggest you just get tested.  No more answers from here however.  EWH

[Treadtkr95]

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