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Testing reliability for syphilis
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Testing reliability for syphilis

Dear Dr, I stupidly performed unprotected oral sex on a man whose sexual history I don't know about two weeks ago (he didn't ejaculate). I was probably obsessing, but I felt like I was getting a sore throat and hurting glands afterwards. I had a blood and urine test for all the most common and dangerous STDs a week after that, and everything came back negative. Anyway, over the next week I started to feel a bit unwell, with a sore throat and hurting glands in my throat, my tongue became kind of furry, and I got something like a small mouth ulcer on the roof of my mouth. I realize that I could just be isolating all these symptoms from others just because I know that they indicate syphilis infection, but I started to freak out that I had taken the test too early and it had returned a false negative. So I went to the doctor yesterday and requested another blood test, the results of which will come back in a couple of days. If I'm honest with myself, I guess I expect it to be negative too - but that doesn't stop me stressing out. I guess I want to know how reliable the syphilis blood test is, particularly in the early stages of infection - and whether, once the symptoms of primary infection are showing, there is a chance that the things the test is looking for might not show up. If I have these two blood tests saying that I'm negative for syphilis can I basically be confident that I really don't have it and move on?
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Welcome to the STD forum.

The risk of syphilis in this situation is extremely low.  You don't say your sex, but if you're a woman and your partner is heterosexual -- and if you are in the US or other industrialized country -- the chance your partner had syphilis is virtually zero.  If your partner is a gay man and this was a casual pick-up sort of event, the risk is higher, but still very low.

If you really have an oral ulcer, then syphilis has to be a consideration.  But sore throat is not a likely syphilis symptom -- and it sounds like you and your doctor are not sure there is actually an oral sore present.

However, you wasted your money on the STD tests done so far.  It is too soon for the syphilis blood test (or any other STD blood test) to be positive; typically it takes 4-6 weeks.  And since it was your mouth that was exposed, there is no way you could have caught genital gonorrhea or chlamydia that would have shown up on the urine test.  However, a throat culture for gonorrhea might make sense.  

So wait until 6 weeks have passed and have another syphilis blood test.  Almost certainly it will still be negative.  As implied by my comments above, if this is a male-male situation, then perhaps you can contact your partner and persuade him to be examined and have a syphilis blood test; if negative, you're in the clear.  Otherwise, keep working with your doctor about your oral symptoms.  But don't lose a lot of sleep over this.  Oral sex is generally safe sex.

I hope this helps. Best wishes--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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