saliva contact but sore at 27 days

[123worried123]

Hello Dr. and thanks for providing this informative service.  I have read previous posts regarding my exposure but would appreciate insight in light of symptoms.

On Oct. 13th I regrettably visited a strip club.  At the end of a dance. The dancer spit on her hand and rubbed my penis for no more than 30 seconds. I was not expecting this to happen, was shocked, but stopped it quickly.  It did seem there was a fair amount of saliva on her hand.  However, I understood this to be a zero risk encounter and had unprotected sex with wife 17 days after exposure.

18 days after exposure, I experienced urethral discomfort that was constant and sometimes more painful upon urination.  These symptoms did not seem vague in nature though I can not rule out genitally-focused anxiety as I was experiencing an extreme amount of anxiety regarding the exposure.  So, at 25 days after exposure I went to the clinic and tested negative for gonorrhea and chlamydia.  29 days after exposure the urethra symptoms persisted and I developed a red lesion under foreskin.  The lesion was flat, roughly oval, not firm.  So 32 days after exposure I returned to clinic concerned about ngu and the lesion.  The lesion was swagger for hsv and took a blood test for syphilis. I was also prescribed doxycycline 100mg 2 times a day for seven days.  Yesterday, the syphilis blood test was neg.  Prior to taking the first antibiotic my urinary symptoms stopped when I became more worried about syphilis and herpes.

1. Givwn the exposure, could I have contracted hsv or syphilis given the lesion? Wife has hsv1 oral.
3.  If I come back herpes negative, how conclusive is the syphilis blood test at 32 days?
4.  Due to the antibiotic...will this skew future syphilis tests?
5.  If the tests are skewed and I may not have a definitive response regarding syphilis any time soon, given the exposure, and unprotected sex with my wife more than two weeks prior to lesion, does she need testing?

Thanks in advo

[123worried123]

Hello Dr. Hook.  Test results today, as you confidently predicted were negative.  I sincerely appreciate your patience and knowledgeable responses in regards to my compulsive questioning.

As a note to others, who by reading this forum I am sure are also suffering severe anxiety, I would like to discuss howmy anxiety manifested itself into OCD and caused me a great deal of impairment over the last two months.  

First, when we are anxious about something we are often hypervigilant and scan our bodies for any particular symptom we have read about.  Due to this heightened awareness, we pick up on normal physical or physiological process that are perfectly normal, but are attributed to the suspected STD.  Additionallyy, the physiological aspects of anxiety can also cause physical symptoms all of its own, that can further be attributed to an STD.  When we are rqcked with anxiety, we disregard information that may disconfirm what we are scared of (e.g. a negative test) and emphasize information that confirms our fear (e.g., imperfect sensitivity of any particular test).

I developed compulsive behaviors of examing my body, reading this forum, and constantly monitoring physical sensations does to obsssive thoughts regarding infection and possible exposure to someone I love.

My advice to others, know these things happen and trust the well informed advice of these doctors who are able to assess the situation with much more expertise and objectivity.  Even if you are certain you are infected, these doctors seem to always be right!  If you were in this situation, relax and take solace and perspective from the Dr's comments.

Thank you for responding to my compulsive questioning Dr. Hook, it did help to reduce my anxiety during this trying time.

[Edward W Hook, MD]

Last answer.  There is still no reason for you to worry that this is HIV or any other STD.  If the ulcers bother you, you should see your doctor.   I am confident your tests will be negative. EWH

[123worried123]

To be more descriptive regarding the tongue ulcers, they have a raised border with an ulcerated center.

[123worried123]

Hello once again Dr.  I am not trying to abuse this forum; however, more symptoms arose today.  I have developed four indurated ulcers on the sides of my tongue and the left lymph node of the neck is swollen.  As a result, I decided to seek further testing for syphilis today and am awaiting results.  I know symptoms alone, particularly with someone experiencing anxiety are notoriously a poor, are notoriously poor for diagnosis.  However, these symptoms appear to fall in line with secondary syphilis and the timing of the events seems consistent with syphilis.  Given all symptoms as of today, am I still likely in the clear?  I will update with results when I receive them and this is surely my last question.  Thank you.

[123worried123]

Thank you for the response.

[Edward W Hook, MD]

No.   EWH

[123worried123]

Hello, I apologize for the multiple questions, this will ne my last.  Yesterday, I developed a small raised ulcer on the inside of my lower lip.  The lesion on penis is about healed, and I wondered if this could be suggestive of secondary syphilis and potentially change the recommendation to seek further testing.  Thanks in advance.

[Edward W Hook, MD]

That is what I said.  No need to repeat it. EWH

[123worried123]

Thanks for your prompt reply, it certainly provided me reassurance.  To be clear given the exposure: blood test at 32 days post exposure for lesion of approximately 3 full days (72 hours) should be trusted an no further testing is required of myself or wife?

[Edward W Hook, MD]

Welcome to our Forum. Saliva is a common lubricant in settings such as strip clubs an massage parlors and is not a vehicle in which any STDs are commonly spread from person to person despite the fact that saliva originates from a potentially infected mucosal site.  

Both herpes and syphilis are spread through DIRECT contact and are not transmitted in saliva.  In the presence of a lesion which has been present for more than 4-5 days, a negative syphilis blood test is highly reliable and should be believed.  

Doxycycline is recommended for 14 days as syphilis treatment and thus partial (7 day) treatment could skew results, IF you had syphilis. There is no reason however for you to be concerned about syphilis and I would urge you to seek other explanations.  What you describe sounds like some other dermatologic process such as a fungal infection, not an STD.

Given the fact that there is no evidence that you have an STD, there is no reason, other than as part of routine health care, for your wife to seek testing.

I hope my comments are helpful and provides some perspective. EWH