Worried about Syphilis

[chicagosleepless]

Dear Dr. Handsfield,

I read about your award, congratulations.  I found your website by reading about it.  I wish I had found it sooner -- I might have saved myself a lot of worry.

My situation: male, unprotected oral receiving and giving with an escort, brief contact, North American city.  I was prescribed azithromycin 500 mg/day for 7 days the day after for a sinus infection.  I began taking the antibiotic literally 12 hours after the contact.  At the same time, because I take doxycycline on and off for prostatitis, I started taking doxycycline.  I took it for 16 days, 100 mg 2x/day; on the last 6 days, thinking to add an extra "kick", I took an extra 100 mg/day or so, for a total of 4000 mg in 16 days.

I am not worried about urethral infections, I was tested by a doctor but my concern is syphilis, which my doctor never mentioned.  My wife is pregnant and I am worried unprotected sex with her might cause a miscarriage.
My questions:
1)  I can test for syphilis at 34 days, but due to professional issues I can't test again for a few weeks.  What is the test accuracy at that time?  When can I be more or less certain that I am 100% home free?  I would prefer to test at 34 days, as the anxiety is beginning to get the best of me.
2)  Should I test for HIV?
3)  When can I resume unprotected sex with my wife?

thank you very much in advance doctor  

[Edward W Hook, MD]

Welcome to our Forum.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Let's go directly to your questions.  The exposure you describe is low risk for most STDs and virtually no risk for HIV.  Most escorts do not have infection and most encounters with infected partners do not lead to infection.  The antibiotics you took would be curative therapy for most STDs, including syphilis, thus there really is no risk for syphilis either, even though it was not mentioned by your doctor.  As for your specific questions:

1.  You could test for syphilis at this time but you do not need to.  As I said above, the doxycycline therapy you took would have been curative if you ha syphilis.

2.  There is no medical need for HIV testing.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  If you test for HIV, you are doing so for your own peace of mind.  HIV test results using standard HIV antibody tests are definitive at 8 weeks following exposure.

3.  I see no reason related to the contact you describe to abstain further from sex with your wife.  

I hope my comments are helpful.  EWH

[chicagosleepless]

Dear Doctor

Thank you for settling my fears. You are a godsend!

One last question and I will not return:

As i understand you, regardless of the semantics of probabilities, testing for HIV as a result of this encounter would be a waste of money as it is a no risk situation?
thank you and take care

[Edward W Hook, MD]

Yes, related to the oral exposure you describe, I see no reason to seek testing.  See my earlier comments related to the syphilis however.  EWH

[chicagosleepless]

Dear Doctor,

Thanks again for your excellent advice.  I understood about the syphilis; no need to test or worry there either, except for peace of mind.
take care

[chicagosleepless]

Dear Doctor,
I hope I'm permitted one last follow-up.  I had a TPHA and an HIV DUO test at 34 days, both were negative.  Given these negative results and the antibiotics I have taken, can I consider myself home free for syphilis, or do I need to test again at a later date?
thanks

[chicagosleepless]

Dear Doctor,
I know that you are very busy and I hope I haven't touched a nerve, but would it be possible for you to answer that last (very last) question?
I would appreciate it.
thank you

[Edward W Hook, MD]

These test results confirm that, indeed you did not get syphilis or HIV from the very low risk exposure you described.    No need for additional testing.  EWH

[chicagosleepless]

Dear Doctor,
I know this will be my last post.  You have been more than patient and I appreciate that.
So...no need to wait until after 90 days?  I can rest assured that I will be no danger to my wife's pregnancy as regards Syphilis?
thanks

[Edward W Hook, MD]

Your wife is in no danger of syphilis from you.  You do not have syphilis.  There is really no need for further testing.  EWH