Syphilis

[johnstrat]

I am a man who had unprotected oral sex with a former co-worker. About 10 days after my encounter I had an urgency to urinate and slight pain in my penis (which prompted my testing).

I had anxiety about getting a STD and was tested for bacterial and viral diseases (Chlamydia, Gono, HIV, Hep B &C, HSV 1 and 2). All came back negative. But I don't recall Syphilis being mentioned. About 3 months after the encounter, I am experiencing itching on my chest and under my armpits. I realize this may be related to something else or anxiety.

My questions are:

1) When they did urine and blood tests for a bacterial infection would they also have done syphilis? I remember them mentioning chlamydia and gono but don't recall them mentioning syphilis.

2) Is my oral sex encounter a risk for Syphilis?

3) Is itching on chest or under armpits a symptom of Syphilis 3 months after the sexual encounter?

4) With Syphilis would there definitely had been a chancre on my penis. Could the chancre occurred someplace else? I did have butt itching and hemorrhoids about a month after the encounter but I'm ignorant if that could have been a chancre.

5) Would abdominal pain be a symptom of Syphilis 3 months after getting it?

Thanks for any information on what I know are some random questions.

[H. Hunter Handsfield, M.D.]

There are only around 9,000 new cases of syphilis per year in the entire United States, and most of those occur in gay men and in heterosexual men and women in a few selected geographic areas and populations, such as southeastern cities and along the US-Mexico border.  Many (most?) of those occur in commercial sex workers, their partner, or others who exchange drugs for sex.  Your risk of syphilis in the circumstances you describe is very low:  almost certainly your partner doesn't have it, and in any case oral sex, while a possible route of transmission, is uncommon.  And none of your symptoms suggests syphilis.

1) Most providers would do syphilis testing when evaluating someone for other STDs, but I cannot say what was done in your case.  But 10 days is too soon to detect syphilis, so probably it doesn't make much difference.

2) Oral sex is low risk for syphilis, but not zero.

3,5) None of your symptoms suggests syphilis.

4) The chancre would occur only at sites of direct contact.  In your case, only the penis.

If you remain nervous or unconvinced, have another blood test.  You can expect a negative result.

Happy holidays--  HHH, MD

[johnstrat]

Thank you doctor for such a quick reply. If I may two quick follow-ups:

1) I was given a week of Cipro when I first went for STD testing. Would that have been an effective antibiotic for Syphilis?

2) Is Syphilis immediately contagious once acquired? If not, how long does it take for it to become so?

Many thanks and I hope you have Happy Holidays.

[H. Hunter Handsfield, M.D.]

I first posted a reply that mistook you for someone else.  If you saw that before I deleted it, please accept my apology for the tone of my reply.  Here is a more appropriate one:

Cipro is totally inactive against syphilis.  Syphilis is contagious only through the chancre and through moist lesions that can develop on the genitals, anus, or sometimes mouth during the secondary stage. The chancre usually appears 3-6 weeks after infection and the secondary lesions typically are present from about that time through 3-6 months, sometimes as long as a year.  After that, syphilis no longer can be transmitted sexually.

I repeat it is almost impossible you have syphilis based on the information you provide.  As I also said, it is fine with me if you decide to get (re)tested to be even more certain.