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Syphilis Questions

Dr. I am posting my questions that I asked in another forum, and you told me to post here to get answers. I really hope you can answer my questions.

I am a heterosexual male. I had condom protected vaginal sex on a few occasions in Europe (Germany and Austria). On one occasion I received unprotected fellatio, but vaginal sex was always protected..

As you may recall I had a rash (resembling psoriasis) on my knees a few weeks back.  I have had tests to rule out HIV, but I am now concerned about syphilis.  I did, at one point, have a minor bump on my scrotum.  It is hard for me to remember what it looked like exactly, but I treated it with a steroid/anti-fungal cream and it went away rather quickly.  

I had blood drawn for the syphilis test, but it's taking a long time to get the results back.  I have a few questions about this situation:

1. Is it possible to contract syphilis through condom protected sex? (I know you say it is rare in North America, but I had sex in Europe)

2. Is it common to contract syphilis, without contracting HIV when having condom protected sex?  Does syphilis penetrate intact skin (such as the scrotum)?  Would this increase the risk of HIV transmission? Do you see many patients who contract syphilis, but not HIV?

3.  Does contracting syphilis (and having it in its early stages) affect the reliability of an HIV test?  I had another negative rapid antibody test at 75 days (almost 11 weeks).  Would this test still be considered conclusive if syphilis were present?

4. Does the syphilis rash ever present like psoriasis and could it be confined to the knees/upper shin?

5. Would the recurrent ulcers on the roof of my mouth indicate anything about syphilis?

6. Would ultra-high levels of stress or applying topical steroids to my rashes for weeks affect the window period of an HIV test?

Please answer as many of my questions as you can, I am having terrible anxiety about this situation, and I would really appreciate your response.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Sorry, I meant most people who contract syphilis do not contact HIV at the same time.  

One last time, condom protected sex is safe sex and does not put you at risk for HIV.  EWH
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Avatar universal
Hello Dr. Hook,

Thank you for your response.  Could you clarify your response to question number 2?  You stated that "Most patients who contract syphilis do not contract syphilis at the same time."  Do you mean that most people who contract syphilis do not contract HIV at the same time? Or the other way around?  I am just worried about this because I have read about a strong correlation between the two diseases.  I am worried that if one organism was able to penetrate the skin that another might readily do so.  

I have read repeatedly that condom protected sex is zero risk for HIV.  Does this apply in the presence of other diseases that are not protected by a condom (i.e. HPV or syphilis)?
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Dr. Handsfield and I share the forum.  You got me for this set of questions.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  further, I agree with him that your fears really do seem over the top. I will do my best to directly and succinctly address your questions.  Before I start however, please understand that I will not repeat myself or answer questions which ask "has it ever...." type questions.  they serve no purpose.  With this as background, let's address your syphilis concerns.

Before I address your specific questions, let me indicate that the exposures you describe were VERY low risk for syphilis.  Syphilis is a rare STD and over 2/3 of syphilis cases in North America and Western Europe occurs in men who have sex with men.  Thus it is most unlikely that your partner had syphilis.  

Now for your questions:
1.  Syphilis is transmitted by direct contact with lesions.  Condoms are highly effective in preventing syphilis.

2.  Most patients who contract syphilis do not contract syphilis at the same time. it happens but rarely.

3.  No, having syphilis does not affect HIV test reliability.  Believe your test results.  

4.  Syphilis is called the great imitator and the rash of syphilis can mimic most any other condition.  If your rash was due to syphilis however, your blood test would be positive- they virtually ALWAYS are.  Thus when you get your negative blood test it will prove that your rash was not due to syphilis.

5.  No.

6.  No, neither stress nor topical steroids would effect the reliability of your HIV test.

EWH
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