Syphilis or not?

[duibhlinn]

Hello Doctor,
I have posted a question before and you were very helpful. Hopefully you can help me out again. My question involves syphilis.
Here the brief history:
I received very brief oral from a male strager (I am male)in an adult theatre. He only put his mouth around my penis head for 2-3 seconds. I pulled away and then he sucked on my testicles for approx 10-20 seconds. That was the extent of the encounter. I had no other sexual encounter after the encounter described above.
94 days later, I got tested for STDs including syphilis. I was concerned about HIV mostly (which is why I remember waiting the 94 days). Anyway all the tests came back negative.
I felt ok about it then and put it behind me. I did go back for a final HIV test at 7 months and that was neg too.
About a week ago (9 months after encounter), I began to get a rash on my upper body. I went to the doctor who said it was Pityriasis Rosea and it would eventually go away after a few weeks. I mentioned that I was concerned about HIV. Syphilis etc and she said it wasn't a cause of an STD though it does resemble the Syphilis rash. I told her of my 3 month Syphilis negative test and she said that that was conclusive and it would have been positive if I had it by the 3 month mark. I do not have any other symptoms such as fever, rash on palms or soles of feet, just the rash.
So, my questions are:

1. Is it possible that I have Sypilis and it didn't show at the 94 day mark?

2. Should I go and get a Spyhilis test again to make sure?

3. What are the chances of a false negative on the first test?

4. If I did have Spyhilis, would the rash have shown up 9 months after the encounter and would I have other symptoms as well?

Thank you for your time.
Sincerely
m

[H. Hunter Handsfield, M.D.]

Many people with syphilis do not see a visible chancre, and syphilis often is diagnosed only when secondary symptoms occur (skin rash, etc) only by blood test in someone who never had symptoms.  Missing the chancre probably is most common in women and gay men, because it is fairly easy to miss or ignore a painless vulvar, vaginal, or internal rectal lesion. It's probably less frequent in heterosexual men, in whom most primary infections involve the penis.

HHH, MD

[worried...]

Dr:

My question may have been vague.  You mentioned in the follow up that someone with syphilis may not have had a chancre.  I guess my question was, how likely is it that someone (in this type of situation, above) would either not have a chancre, or not notice it in the initial stage.  I am just curious if the majority of people would have a sore that would obviously stand out.  I know there are no absolutes but I am wondering, if you have syphilis, would it be likely that you would have a sore that you could easily recognize, or could it be that you would miss the sore and see the rash of secondary syphilis at a later time.

Thank you for your time.

[worried...]

Dr.:

Quick follow-up question, you posted "rash often is the only symptom of syphilis and it can show up any time in the first year."  Is this correct or is the rash often the only symptom of "secondary" syphilis?  I would have thought the chancre would have been a definite sign in primary syphilis, in this instance on the penis and overtly visible.

Thanks, was just curious on the sypmptoms, it seems that syphilis is sort of tricky sometimes.

[whyme2006]

thread jump here
please delete

[H. Hunter Handsfield, M.D.]

Both statements are correct:  "Rash is often the only symptom of syphilis" and "Rash is often the only symptom of secondary syphilis."  Rash can occur in someone who had a chancre (that then cleared up) or in someone who never had a chancre; in both cases, it is the only symptom at the time it occurs.

Syphilis indeed is a complex disease, i.e. tricky.  But this question isn't particularly tricky.

HHH, MD

[brody222]

I also have concerns surrounding Syphlis testing. I myself was tested at 102 days with a negative result, but still find myself anxious. I think this is mainly due to the line of thinking that if a positive result could take up to 90 days to show postive, it doesn't seem too much of a stretch to think that at 102 days (only 12 extra days) may also not be long enough.

I think it would help to understand why testing takes 90 days and whether that number, which almost all of the informational sites quote, is an absolutely maximum number of days that one could have the virus but still test negative.

I hope these questions aren't merely re-hashing, but could you answer:

1) Why can testing take 3 months to show positive?
2) Is 90 days the definitive maximum cap for this? Why?

Again, my apologies if I'm merely restating questions that have been answered.

Thanks

[H. Hunter Handsfield, M.D.]

You can be sure your rash is not syphilis with a negative syphilis blood test 3 months after exposure.  Anyway, your exposure was almost zero risk for syphilis to start; oral to genital transmission can occur but is far less common than by would have had a symptomatic sore (chancre) of the penis--which you undoubtedly would not have overlooked.  And a doctor has given you another diagnosis, which there is no obvious reason to doubt.  But if you're concerned, return to that doctor for her advice.

Specific answers:  1) no; 2) no unless your own doctor suggests it; 3) zero; 4) rash often is the only symptom of syphilis and it can show up any time in the first year (but this does not mean you have syphilis; you do not).

This is your last permitted new thread for another 6 months (see forum rules).

Good luck-- HHH, MD

HHH, MD