Syphilis concerns

[flying_squirrel]

I have a couple questions concerning syphilis transmission.  First, my story- about 3 years ago, I had a one time relationship with a girl I met at a bar.  It included only unprotected vaginal intercourse.  I didn't experience any symptoms of any sort after that encounter that would lead me to believe there was any syphilis infection(or any other STI).  If I understand correctly, there would have almost absolutely been a chancre on my penis if I had been exposed to syphilis at that time with that kind of sexual contact.  About a year and a half later, I had a relationship with a woman who I know, which consisted of unprotected oral and vaginal intercourse, which ended in September of last year. Over a year after that ended, I had unprotected oral sex(receiving and giving) with the same woman about 4 times.  I know for a fact that this woman has not had relations with anyone but me since her divorce 3 years ago.  In October, I developed a bump smaller than a pea about an inch lateral to my penis- not directly on it.  It never developed a crater-like appearance, more like a big, firm pimple, that didn't want to go away, and hurt when I would fool with it. I didn't think a lot about it because of what I'd read here and what I perceived to be my low risk exposure during the last encounter. I Now I'm hyper sensitive to every little thing that happens with my palms, and constantly are evaluating them, and think everything is a symptoms of syphilis.  

Questions-1) What is the time frame(duration) in which syphilis in contageous?  I've read that it can be contageous for 1-2 years, but I believe I read that one of the Dr.'s on this forum said it was much shorter than that.2) Is it possible that I may have had it, passed it to the second woman, and then she re-exposed me to?3) If I did indeed originally have syphilis, and had been re-exposed to it, would I go through a normal progression of symptoms(ie. chancre, rash, etc) again? 4) What does a typical palm rash look like?

[H. Hunter Handsfield, M.D.]

Let's look at the powerful evidence you don't have syphilis.  First, the chance is miniscule, especially if you live in the US.  There are only about 9,000 new cases per year in the entire country.  Most of those occur in gay men and the others in only a few geographic areas, such as the southeast and along the US-Mexico border.

Second, probably fewer than 5% of syphilis cases are acquired by oral sex.  Among heterosexuals, probably fewer than 200 cases occur per year from oral sex.  Statistically, you're not likely to be one of them!  (There aren't data on this, just rational extrapolation from what is known and I do not vouch for the exact numbers.  But you get the idea.)

Third, your symptoms don't suggest syphilis.

Fourth and most important, you don't mention your diagnostic test results. If you haven't had a blood test, of course you need to do that.  If it is negative, you're home free - and your symptoms don't matter.

To your specific questions:

1) Typically syphilis is maximally contagious from the time the chancre appears (usually 2-6 weeks after exposure) and for the next several months.  Infectiousness can continue for a year, and rarely as long as 4 years, but it is quite rare after 6-8 months.  Even during those first several months, it is intermittent, not continuous.

2,3) Although people remain susceptible to and can be reinfected with syphilis, previosly infected people are partially resistant.  But only if they are treated.  Untreated people probably are immune until after they are cured with penicillin. So the scenario you describe is biologically very unlikely and statistically almost impossible.  When it happens, however, the natural course may be modified, e.g. with less noticeable chancre or other symptoms.

4) Painless, non-itchy red spots or patches, sometimes with a flaky component.

As indicated above, the chance you have syphilis is misicule to zero.  But since you're nervous, stop speculating and get tested.  You can expect negative results.

Good luck--  HHH, MD