QUESTION

[kissedagirl1]

Hi doc,

I received oral sex from a sex worker.  I was examined and ran a full battery of tests four days later.  I was traveling so the doctor empirically treated me with doxycycline said my urine tests were fine and without any outward signs of infection for gon...... no worries and to get checked when I returned home.  VDRL was non-reactive then. I did test when I got home and tests were negative x2.

I read a very informative post on here that stated Doxycycline would have aborted syphillis soon after first dose?  I had unprotected sex with steady girlfriend three or so days after finishing seven days of meds.  Was that safe?  I did not see any signs of infection on the girl who gave me oral would I have? is that a precursor to infection she must have a lesion? I had another vdrl 49 days after non-reactive is that definitive?  I read had I gotten the disease I would have positive results for some time even after cure?  I guess I want to know for sure that my course of action against this disease was correct four days after negative VDRL one week of doxy twice a day.......did I abort any potential infection, did I put my partner at risk having sex three days after doxycyclene was finished.......is there any chance i was infected in the midst of cure and infected her? was it too early even had I been infected to pass it on to her?  I read takes at least three weeks to be contagious......I only had sex with her that one time that I am unsure of I then waited until i had the second negative, please put my mind at ease. I am a little worried and want to do the right thing.  Thanks.

[Edward W Hook, MD]

I'll be happy to put your mind at rest.  A few facts, then I'll put them in context:

1.  Syphilis is only sexually transmitted by lesion contact.  There was no mention of a lesion on the CSW and, more importantly for your GF, you did not have one.
2.  Doxycycline is effective against syphilis
3.  When a person acquires syphilis, the infection "incubates" for up to 21 days before a lesion appears and infection can be transmitted to others. this permits administration of preventative therapy which is what you had.
4.  Syphilis is a rare disease.  It is unlikely that the CSW had syphilis

Putting these 4 facts together, IF you were exposed to syphilis (unlikely), the doxy would have prevented the infection from taking hold in you.  Your subsequent lab tests prove that you did not get syphilis.  Your GF is/was at no risk

Hope this helps. EWH

[kissedagirl1]

Thanks doctor that was a big help.  Did I have enough? seven days twice a day of doxycyclene.  I had some things that may or not have been chancre I chalked them up to cysts and ingrown hairs for no other reason than those are common.  I was using cream for jock itch and sometimes I can clog the pores and develop pimples or other irritations.  I chalked these up to that, they were also painful after squeezing and as I recall Chancre is painless correct?  Is the doxy really as effective as I have read, effectively preventing syphillis transmission a few hours after first dose?  Lastly, I think my negative VDRL at 49 days proves I do not have it definitively?  does it also prove I never had it? We had sex at least a week before 21 days and then not again until the second negative VDRL so I guess this might be much ado about nothing agree? can I finally put this behind me?  i am comfortable about all of my other risks.  I had negative GOn, CHl, Trich tests, I have HSV1 already, HIV rapid test negative 90 days. No signs of NGU clear urine...... i think i covered all possible offenders?  Thanks again.

[kissedagirl1]

One more thing I did not see a lesion but would I have where would it have been on her?  Inside her mouth?  her throat?  her lips all of the above?

I would guess if she had a lesion she would have known it and maybe gotten treatment I have read any treatment at all and you effectively prevent transmission is that true?  Thsi is my last post.  Thanks again.

[kissedagirl1]

Doctor,

I am sorry to chime in again but I was reading more posts on here and got to mine, I see you were on here and answered others questions.  I am sorry for taking your time, MY only question really........... forget the two above posts:  I had original VDRL 4 or 5 days after event then 7 days of doxy two a day then 3 days later had unprotected sex is there any way possible I infected her?   Does the doxycyclene effectively halt transmission a few hours after first dose making me non-contagious as I have read?  I probably should have been more to the point originally.  I am sorry.

[Edward W Hook, MD]

STOP!  I will repeat myself once.  After that you have to look elsewhere for reassuraences:

1.  You took plenty of doxycycline
2.  You do not have syphilis, even if you were exposed which is highly unlikely. You have blood tests which prove this.
3.  If you do not have the infection, you cannot give it to others - your GF is not at risk

EWH

[kissedagirl1]

I am sorry for the irrational behavior.  Thanks for the reassurance I only came back because while I know I do not currently have the disease I wondered about the timing of the doxy and my sex with her.  I was concerned that I did not have enough doxy which you addressed and that I did not wait the appropriate time to have unprotected sex.  I read on one of Dr. Handsfield posts that after first dose of doxycycline or azithromycin you would effectively prevent transmission, and I had fourteen doses of doxy.  Like you say if I did not get it I could not transmit.  Thanks for your patience, I paid because I know zero about the disease and the testing center really did not go into detail so I appreciate  having the resource to ask a question and gain some knowledge from your expertise.