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Potential Syphilis and Testing Question

Hello.  Thank you so much for the service you provide.  I am a bi-white male and occassionally have safe encounters with other men including receiving fellatio.  I always try to practice safe sex. Over the past couple of months I have been treated for prostatitis using Doxy, Cipro, and Levaquin at any given time.  7 weeks ago I was on Doxy, then 1 week of Levaquin, and the past couple of weeks on Cipro.
I do allow stimulation of my scrotum via mouth, hence my question.

Over the past 7 weeks I have had a couple of guys lick my scrotum, and masturbate my penis with their hands.  One guy during at the beginning of the 7 weeks did perform non-protected fallatio for only a few minutes (as I do not like the risk and I was on Doxy at the time.).  10 Days ago, I noticed a small scab on my scrotum (I also shave my genitals and have had folliculitis in the past and was on Cipro at this point).I picked the scab off, and placed hydrogen peroxide on it.  It fizzed and it was a bit painful and bled a little when I squeezed it. It looked a lot like a syphilis Chancre (an ulcer with a yellowish crust and a crater edge).  It seemed to weep water just a little bit. Over the next week it started to look like it was slowly healing with the crater starting to shrink, but still had a little yellow crust in it and when squeezed hurt.   Around 6 days ago I started using a clindamycin gel which helped.

On Friday of last week, I went to a doc in the box and he looked at it and said it looked like Folliculitis.  On Friday I started taking Doxy again (100mg 2x/day) as I was concerned it was Syphilis and have been taking it ever since.  On Monday I went to my derm and he said folliculitis until I mentioned possible syphilis and then he suggested to be safe an RPR blood test.  I had one done and it came back negative.  My question is what is the chance that I had syphilis and what is the chance that I would have a false negative if I was on doxy for three days before the test?
3 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Trying to distinquish between syphilis and healing folliculitis on the basis of time to healing while on doxycyline is not worth attempting.  

Syphilis can occur anywhere, at any site of exposure. The penis is certainly more common than the scrotum.

Preventative antibiotics taken during periods when you think you might be at risk will just confuse things, just as taking it this time did.  How can you say it helps with anxiety-look at your thread.  You are anxious and the doxy has just confused things.  I would hope you would learn that this is not a wise idea.

All of the activities you describe are considered safe.  EWH

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Avatar universal
Thanks for the quick reply Dr. Hook.  How long would it take for the "chancre" to cure after starting doxy if that were what it was..  Also, my derm said he almost always sees syphilis on the penis.  Is that correct?    Do you have any statistics on false negative based on days on doxy?  The physician I saw first, to me was skeptical as I think he was a PA and not up to speed on STDs.  

Can I ask, if I ever find myself in this situation again where I am concerned about an oral episode, what is a preventative dosage of doxy as I usually have extra from prostatitis treatment.  I mean, is there a dose I can take immediately after exposure just in case?  I am not condoning abuse of antibiotics, it is just if I have some, it beats weeks of anxiety and stress as we all make mistakes.

Also, what do I need to be most concerned with from an STD perspective, ie are the following relatively safe?  mutual masturbation, fingering, touching (assuming I see no lesions).  I know I need to be careful about HPV and herpes, but what about others for male to male.. statistically speaking and are there any "signs" I should look for? Thanks.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  I'll try to help but your doxycycline will make it a bit difficult to be 100% sure.

Syphilis is a rare disease, in fact it is very rare with less than 10,000 cases occurring in the US, among a population of over 350 million. Furthermore, oral syphilis (it sounds as though your only exposures were oral) is a rarity among all cases of this rare disease.  Finally, you have an excellent alternative explanation (folliculitis) which was considered by not one but two health care providers.  All of this makes syphilis unlikely.  Doxycycline is treatment for a very early syphilis infection and might have kept the RPR from being positive but given all the other things which argue against your lesion being syphilis, I would feel comfortable in telling you that there is almost no chance that the lesion you noted was syphilis and furthermore, would assure you that even in the tiny chance  it was, the doxycycline would have cured it.  At this point my advice is to put your concerns about syphilis aside and move forward.  I see no reason for further concern of for additional testing . EWH
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