inconclusive testing

[manworried]

8 weeks ago, I performed unprotected oral sex on another man.  He gave me a hand job and broke the skin at the base of my penis, and I masturbated both of us.  2 weeks later, a red area began to grow on the head of my penis.  it was mild, painless, flat and about 1 cm in diameter.  It disappeared on its own 4-5 weeks later, although there is still a very faint sign if i look very closely.  The local health department looked and could not see anything out of the ordinary.  They are concerned about syphilis and gave a blood test for HIV and Syphilis.  Both came back negative.  They said that it means nothing until 90 days, so come back in 30 days.  Since the lesion came and went  already, what are the chances that I had a false negative reaction at 8 weeks.  I am too nervous about this to wait 30 days.  Will the test be any more accurate at nine or ten weeks?

Also, my wife performed oral sex on me at about the two week mark (after possible infection), right before I realized that the red area was of concern.  We have had no sexual contact since.  What are the chances that she contracted syphilis if I have it.

My wife is ~22 weeks pregnant, and was ~16 weeks at the time of our first and only sexual contact (oral) since possible infection.  Since she can not get a conclusive test for a few more weeks either, what should I do?  She is not aware of a problem, but I don't want to scare her if nothing is wrong.  Alternatively, I am aware of the dangers and will waiting till I get a firm answer be too long?  Would a doctor give her penicillin now anyway based on the situation?  Or would they wait until she tests positive.  What do I do?  How late in the pregnancy is too late?

Lastly, if I have syphilis, what are the chances that there is a problem with the baby, and what are the chances that treatment will avoid a horrible outcome?  What is the latest she can be treated?

[Edward W Hook, MD]

Reading your post, it appears that your major concern is syphilis.  I agree with the folks you saw at the health department that the description you provided is consistent with syphilis but this would be a most unusual way for syphilis to be transmitted. Syphilis is a rare disease and there are other dermatological problems which might present similarly..  In addition, if the sore you noted was syphilis, your blood test should have been positive after it had resolved.  For all of these reasons, I am comfortable in tell you that the chance that what you describe was syphilis is close to zero.  Having said that, I  don't think we need to deal with your questions about syphilis in your wife or congenital syphilis.

In terms of HIV, I am not perfectly sure of the timing of your most recent test. Irrespective however, once again., HIV transmission through masturbation is unheard of and the lesion you describe is not the least bit suggestive of HIV.  In addition, if you have acquired HIV, you would have developed a positive test by 6 weeks after your exposure at least 95% of the time.

So what could it be.  I have  no idea.  A fungal infection perhaps- the time course is about right.  You may never know but what I can say is that it certainly was not syphilis or HIV.

Hope this helps.  EWH

[manworried]

Although I am thrilled that you are confident I am not infected with these two terrifying diseases, I would still like your opinion on the statement the health department made that I should come back in 30 days.  Why would they say that if the test is conclusive?  Any thoughts?  Thank you so much for your help.

[Edward W Hook, MD]

They are saying the "standard" answer.  Their statement does not take into account the natural history of the lesion that you described which is what caused us to focus on the possibility of syphilis to start with.  EWH

[manworried]

thank you.

[manworried]

Doctor,

this weekend, my wife had a rash break out on her abdomen.  I have read this is a symptom of secondary syphilis.  Naturally, my fears are renewed.  I will not be at the 90 day mark for another 2 weeks.  i am terrified of what the consequences would be if my pregnant wife has this disease.  can you please answer the rest of my question, I am begging you.

[Edward W Hook, MD]

Please get over this.  You do not have syphilis.  women get rashes all of the time in pregnancy and are regualrly checked during pregnanacy for syphilis.  EWH