Testing results, clinic information - please answer.

[ClaytonLake]

I apologize in advance for my long-winded post.  I don’t know how else to explain.  Once a year I get tested for STDs.  I like the peace of mind once a year, even though I practice safe sex.

Each year I see the same “case-worker” and then one of two doctors for my annual STD screening.  Due to my sexual activity, my caseworker feels that syphilis blood work is not needed.
This year my caseworker was out with the flu and I dealt with someone new.  He basically bullied me into a blood draw for syphilis, claiming there was an outbreak in our area.

The two sexual encounters I had prior to the blood draw were:
Person A: 43 days prior to blood draw (just over six weeks)
Person B: 40 days prior to blood draw (just under six weeks)

Both encounters were 100% protected intercourse and then unprotected oral.  Both are women that I know.  No one can be 100% sure of the other person's activities, however.

I had never really entertained the thought of syphilis in the past, knowing that my risk was low.  This caseworker certainly got my attention and produced quite a lot of anxiety.  One week later I called to get my test results, thankfully my original caseworker was there.  When he saw that I had blood drawn for syphilis he had a lot of questions as to why.  I relayed the information told to me and he became very upset.  Not only does my geographic area not have a syphilis outbreak, my entire state has not seen one case yet this calendar year.  

The other caseworker outright lied to me; for whatever reason only known to him.

My tests all came back negative, including a non-reactive test for syphilis.  The mental / emotional “damage”, however, is not so cut and dry.

1) Chlamydia – WebMD states that it could take up to six weeks to become present and detected by tests. With my negative test at just over 6 weeks for person A and just under six weeks for person B, may I be 100% certain of the negative result?
2) Syphilis – same question as number one (above).
3) Syphilis – I assume that if a chancre were to develop, it would not be overnight.  I viewed pictures on line of chancre , but what would be warning signs if one were developing?
4) Syphilis – what medically makes gay men more prone to this disease than straight males?
5) Syphilis – everything that I’ve read on line states that the chancre sore would develop where the disease entered the body.  If a person contacted it orally, would that chancre be oral / facial?  If the person contacted it through genital exposure and wore a condom, would the chancre be at the spot where the condom ends and skin is exposed?

6) Bottom line – can I be assured, via the non-reactive test, that this is a total non-issue for me?

I understand that you can-not do a diagnoses on line, I’m not asking that of you.  I’m hoping to clarify the questions I have above (especially the time tables of over six weeks and just under).  This will go a long way towards putting my mind at ease.  Thanks.

[H. Hunter Handsfield, M.D.]

It is unlikely that anybody intentionally lied to you.  Most STD clinics recommend and perform routine syphilis testing for all patients.  But individual clinicians in those clinics may recommend it more forcefully than others, and in low prevalence settings or states like yours, some providers may have the freedom to waive the normal procedure.  In other words, it is possible that the more forceful provider is the one who was following the letter of the clinic's policy.  That's not to excuse a bullying attitude, or false information (whether intentional or not).  But I'm not going to try to judge whether he was behaving inappropriately or not.

1) I try to avoid he said/she said debates based on web-based information; too much risk of misinterpretation out of context.  My guess is you misunderstood the WebMD information.  Symptoms of chlamydia tests may be delayed several weeks, but the tests definitely become positive within a few days of infection.

2) Syphilis testing takes 4-6 weeks to become positive.

3) The chancre itself is the first symptom; there is no "warning sign" before the lesion begins.  It starts as a red bump that ulcerates within 1-2 days; it usually is painless.

4) Syphilis is easier to recognize in heterosexual men and women because more lesions are external and visible; in gay men, chancres commonly are inside the rectum and not apparent.  
More important, some gay men have many partners in rapid succession and often anonymous ones, so tracing partners and stopping transmission is more difficult than in heterosexuals.

5) As you say, a chancre can occur at any sexually exposed site--genitals, anus, mouth, vagina, or at above the rim of a condom.  I'm not sure what your point or question is.

6) You are overreacting.  Why are you so concerned about it?  The fact that you were tested this year and not with previous annual exams obviously does not mean your risk is higher than in past years.  Equally obvious, in a state with no syphilis in recent years, and with the safe sex practices you describe, you cannot be at serious risk for the disease.

Good luck-- HHH, MD

[ClaytonLake]

Thank you for answering my following up questions, I appreciate your time.

The point of my narrowing questions in regards to potential lesions for syphilis is this:  if one contacted the disease orally, is it possible for that lesion to appear on the tip of the penis?  Do the sores have a pattern to them, or are they random?

IE - if I were exposed (and I know it's low / zero risk), if the lesions would only appear in certain exposure places they would be easier to detect.

In regards to why I'm worried - I was taken aback by the testing process and out of my comfort zone.  The past week was a scary one, educating myself on syphilis.  I want to make sure I'm properly educated.  I don't mind a week or so of anxious research for a longer period of time with a clear mind.  Syphilis seems to be a real "heavy hitter" with clear long term dangers.

[H. Hunter Handsfield, M.D.]

Sorry, I have nothing to add.  You have zero chance of having syphilis from the exposures you described above.  There are many sources, online and off, where you can educate yourself about syphilis.

HHH, MD