Syphilis from Fellatio Probability/Test Results Masked by Amoxicilin Use

[WonderingHelp]

On 7/15 and 8/6, I had two unprotected oral (I'm a male) sessions with a CSW. Each lasted a few minutes (2-5).

After my second session, noticed two small pimple like bumps near the head of my penis. They were slightly bleeding, I think from her teeth. 2 days later, developed two more. These sorts of bumps are things I have had for years, I do not think they are Syphilis chancre. From my reading, I am almost 99% certain I have herpes.

On 8/8 I developed a bad fever, sore throat, swelling of my lymph glands making swallowing difficult. It seemd to get a little better, but never totally went away. I resisted antibiotic treatment initially since it seemed to be getting better and I was soon to travel home. It didn't, got much worse, to the point I could no longer swallow. This was 8/20.

Saw a doctor. She thought strep infection and prescribed amoxicilin for 10 days, 3 tablets daily, once a day. Symptoms cleared within 4 days and I was better within 8. The two sets of sets of pimple like bumps on my penis, which I had popped, but had been clearing up slower than they had in the past also cleared up within that time.

I do not think I have developed the other symptoms of syphilis, but I am concerned. My wife has developed a small wart on her upper thigh that I think is HPV. Between the time of the first sets of pimples on my penis 8/6 and 8/31, my wife and I did not have intercourse.

My questions:

1. Truly how high risk is the activity of receiving fellatio for syphilis? I have read the reports and it does seem higher MSM contact.

2. Based on the description above, how likely would it have been that I would have passed syphilis on if I had it either before I saw the bumps or later after we resumed sexual activity?

3.Would my Amoxicilin treatment mask any syphilis test results performed later?
Getting fully tested today.

[H. Hunter Handsfield, M.D.]

Amoxicillin indeed would mask syphilis, but it would do so by curing it: although not routinely recommended as standard syphilis treatment, it would abort an incubating case or treat it effectively if an early infection was already established.  Further, syphilis is rare in heterosexual women, including CSWs, most of the US and western countries.  And although oral-genital transmission certain can occur, most cases are acquired by vaginal or anal intercourse.  Combining the low likelihood of exposure, low transmission risk, plus the amoxicillin, you can forget about syphilis.

As to the cause of your genital lesions, fever, and sore throat, you don't describe enough detail for me to judge the causes, or to judge your certainty that you don't have herpes.  Certainly that possibility is raised by "pimple like" penile lesions.  Unless you have been professionally evaluated and herpes excluded, that seems like something you need to address.  But that's probably unlreated to teh sore throat and fever; most likely that was just a garden variety virus or possibly strep throat.

I think those comments address all 3 of your questions.  Best wishes--

HHH, MD

[WonderingHelp]

Doctor,

Thank you for your reply. I had to trim my post a little due to the character limit. One follow-up question if I might just to clarify.

Based on my description of when I had the oral sex with the CSW, dates the lesions appeared and stopped and started again having sexual relations with my wife, is there a possibility that I may have passed on syphilis to my wife?

I ask only in that my amoxilicin may have treated me, but I am concerned that if I did have something that I may have passed it to her. On the other hand, if it is extremely low likelihood, I will drop it and hope that this stupid episode will never recur and trouble my marriage again.

I am getting tested since I really do suspect the Herpes. Thank you for this site. It is worthy work.  I would be more than willing to pay for this follow-up question, but did want to keep this with my original post. Thank you.

[H. Hunter Handsfield, M.D.]

If you have genital herpes, that undoubtedly is the main risk to your wife--unless, of course, she already is infected, which is a good bet.  The likelihood is very low you acquired anything transmissible from 2 episodes of fellatio. But of course I have no way of guaranteeing anything, of course.

HHH, MD

[WonderingHelp]

Thank you for your reply.
Life is a lesson.

[WonderingHelp]

Hi, Just an update. Lab had said 2-3 days, but had results when I called today. Was a private lab. Negative for syphilis, but I do have Herpes. Little freaked out (doesn't need to be addressed here) since I am realizing I have probably had this for 20 or so years....

Final (I swear question) question: I had two sets of small pimple like lesions. Most of the references to chancres that I have seen on this and other  sites seem to refer to a single sore and they seem different than Herpes. Would a syphilis chancre typically have a similar appearance to Herpes sores?

Anyone reading this thread may also find these forum links of interest:

http://www.medhelp.org/forums/STD/messages/3241.html
http://www.medhelp.org/forums/STD/messages/935.html
http://www.medhelp.org/forums/STD/messages/3094.html

Truly meant it when I suggested I would like to make a contribution. Have looked, but have not found a place on the site where I could make one. I have read through the forum often over the last few months and have found it valuable.

Thread can be closed beyond this question. Thanks again.

[H. Hunter Handsfield, M.D.]

The skin lesions of herpes and syphilis can mimic each other.  Since HSV-2 has been diagnosed and syphilis has not, and since genital herpes is about 10,000 times more common tha syphilis in people with genital lesions, you can put syphilis out of your mind and deal with the herpes.

Use the contact link, or otherwise find information on the MedHelp home page to learn the address and phone number, if you want to follow through the a contribution.

Best wishes--