HIV Risk

[questionguy520]

About 12 days ago I had oral sex with a "massuese" of chinese origin. I was the insertive partner. It was essentially unprotected (saran wrap). Two days later I noticed a pain in my testicles and a slight drip, but no smelly discharge or anything additional. I went to an urgent care center and they had a urine analysis done which showed bacteria in my system. They ordered a round of blood tests and told me I most likely had Chlamydia. Also, I was given an intramuscular shot of Rocephin.

The Rocephin must have done a number on me as the next two days were absolute hell; fatigue, itching, feeling of fever, most likely a Jarxish-Herschmeir (SP?) type reaction to the bacteria. I was also given a prescription to 2 pills of a total of 500mg of Azithromycin that may have exacerbated those symptoms. I received a call from the doctors office stating that my test results had come back and I had tested positive for Syphilis. I was suprised that I had symptoms from Syphilis only after two days. I was given an additional prescription for 100mg of Doxycycline 2x daily for 2 weeks. I am about halfway through and beyond minor side effects from the antibitoics, I am feeling MUCH better.

Basically my questions are:
1. Am I at a higher risk for HIV from this encounter now that I have become infected with Syphilis from this individual?
2. What would be your recommended screening/testing dates to know that I am not infected?
3. Am I overreacting?
4. Sidebar: Do you think my Syphilis treatment regimen is adequate?

[Edward W Hook, MD]

Thanks for your followup.  If you would like to make a donation to the American Sexual Helath Association (ASHA) it would be put to good use.

I'm glad things have worked out for you. EWH

[questionguy520]

1. I apologize if I seemed defensive to your recommendations, I just find all of this new to me.

Update* I had blood drawn last Thursday for a full panel of STD's, including Early Detection HIV and antibodies. On Sunday I went to the emergency room bc I was wither having an anxiety attack or having a bad reaction to the doxycycline. The ER doctor was curious as to why I was prescribed Doxy instead of the standard Penicillin treatment. It was most likely due to me now being in a different city from where I originally saw the urgent care doctor. I was taken of the Doxy by the ER doctor and given 2.4 MU of penicillin. I feel much better and I assume since I am allergic to Tetracycline, Doxycycline was not a good antibiotic for me.

My test results came back positive on the RPR 1:2, but negative on the confirmation test. This was before my shot of penicillin, but after the rocephin,azithromycin, and doxycycline. So now, even if I had a false negative for any reason, I feel that my syphillis was adequately treated. I have been referred to an internal medicine doctor and will follow-up per his guidelines.

I also came back negative for everything else. I am elated that I can finally breathe again and put this behind me.

*Dr. Hook or Handsfield, I appreciate your time and service. If you are able, please provide me with a charity of your choice and I would like to make a donation in your names. Thanks again.

[Edward W Hook, MD]

1.  As best I can tell, you do not want to hear what Both Dr. Handsfield have told you.  Your syphilis was diagnosed coincidentally to your evaluation for symptoms.  You did not get syphilis fro oral sex two days before you were tested.

2.  It is not possible to know how long you were infected, or whether or not you may have been treated for this infection in the past.

3.  It will be difficult to prove that your test was due to some otherwise I diagnosed autoimmune disease.  EWH

[questionguy520]

UPDATE:

Called the original clinic and gained more perspective. My initial results were 1:2 on the RPR test. I believe that is the weakest or one of the weakest reactions that can be measured. The STA was also reactive. The doctor then stated that the results are equivocal based on a follow-up test in 2 weeks. I actually had the 8 panel done yeaterday with HIV early exposure and obviously Syphilis. I believe three things may come out of this:

1. My Syphilis reaction was based on the oral sex and was in an early stage of infection and something else (bacterial infection, UTI, NGU) may have caused the symptoms and led me to the doctor and the test picked up syphilis.
2. I have been infected before in my life and cleared the infection or killed it with another dosage of antibiotics for an unrelated illness.
3. My test was compromised by something else. My mother has an auto-immune disease yet I have never been tested. Another bacterium may have caused the test to show a positive at a low level.

Do you agree or have any additional comments? I appreciate your thoughts on this..

[Edward W Hook, MD]

As I said earlier, syphilis would have not been apparent in two days after an exposure.  I am sure that Dr. Handsfield would agree.  Thje average time to onset of syphilis is 21 days from exposure to lesion formation (and having a positive blood test).  

Trying to sort out the timing of your infection will be difficult other than to again say, you did not acquire syphilis from oral sex two days earlier.  EWH

[questionguy520]

By the way, all my other blood tests came back negative from the doctor. Only thing I am worried about is HIV.

[questionguy520]

Is it possible that I acquired Syphilis and an NGU/UTI at the same time and the blood test picked up the Syphilis and the NGU/UTI created the symptoms? I have not had any Syphilis symptoms, most likely due to the immediate treatment. That, or the test took some other bacteria and recorded it as Syphillis.

Dr. Handsfield, in one of his posts stated that Syphilis can come on within 2-20 days. I do have a good immune system which may explain that as well?

Would either of these scenarios make sense?

[questionguy520]

Now I am even more nervous!

[Edward W Hook, MD]

You are correct, there is no evidence HIV is acquired through receipt of oral sex.  

Please let us know what your blood test shows.  EWH

[questionguy520]

Thank you for your advice. I find this all unusual as well. I did have an early exposure test which did not show any HIV. I plan on getting some more testing this week along with the 3 ora quicks I have taken that did not show any HIV. I called the urgent care center to get my Syhpillis number (1:4,1:32,etc) but they have not called me back with the results. I am hoping that something in my bloodwork (bacteria,antibodies,etc) made the test find Syphilis when in reality it was something more like NGU or UTI.

I thought HIV was not able to be transmitted via receiving (blowjob) oral sex?

[Edward W Hook, MD]

Welcome to our Forum. Your situation has a number of unusual parts to it.  The biology of syphilis is such that it is effectively impossible for syphilis to become established just two days after exposure.  If you acquired syphilis, I am confident that you acquired it sometime before the oral sex you received.  Further, I can say with confidence that the J-H reaction lasts less than 24 hours so that if you had two days of symptoms, something else may have contributed.  

I'm glad you are feeling better.  Given the nuances of your situation, my advice would be for you to consult with an STI or at least Infectious Diseases specialist regarding follow-up.

Regarding your specific questions:
1. Am I at a higher risk for HIV from this encounter now that I have become infected with Syphilis from this individual?

The links between syphilis and HIV are strong and it is important that you have follow-up testing for HIV 8 weeks after your initial diagnosis of syphilis. At the same time, most people who get syphilis do not get HIV.  Was a HIV blood test done at the time of your initial evaluation?  If so and you had a negative HIV blood test at the time your syphilis blood test was positive, that is strong evidence you did not get HIV although further testing is recommended.

2. What would be your recommended screening/testing dates to know that I am not infected?

See above.  A re-test for HIV is appropriate.

3. Am I overreacting?

I don't think so although I would not follow-up with an urgent care center.  Better to see an well informed specialist who can follow up with you over the next few weeks.

4. Sidebar: Do you think my Syphilis treatment regimen is adequate?

Yes, 14 days of doxycycline is a recommended therapy for syphilis is persons who have allergic reactions to ceftriaxone (Rocephin).  I suspect those who treated you were concerned (as am I) that your reaction was a reaction to the ceftriaxone.

I hope these comments are helpful.  EWH