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Link Between Syphilis & HIV?

Jul 6, 2005

Hey Doc,

I had a brief unprotected anal (insertive)sexual encounter (30 seconds tops) with another male of unknown status.

I started PEP (nelfinavir, 3TC and 4DT) within 12 hours and developed a bad rash all over my body by Day 10. I saw the doctor who was surprised by the skin reaction (red, hot, scaly, over neck, arms, chest, back, legs, light on palms and feet). I suggested syphilis and she agreed -- we're waiting on blood test confirmation of this. I stopped the PEP after 11 days (due to worry about rash being caused by allergic reaction to PEP).


1) I did not have an open sore on my penis during this last unprotected encounter and I did not perform oral on him. Does this eliminate the elevated risk of contracting HIV if I do in fact have syphilis?

The increased risk comes from the cancres and not just simply having the syphilis virus in my blood stream correct? If I had no open sores or cancres on my penis there is no increased HIV risk from this most recent encounter? I did not perform oral on him ... only insertive anal.

2) 11 days of PEP -- enough or not? Hard to say I guess. I imagine the first 24-72 hours are the most critical. If the virus were to attach itself to my body, it would have done so by now (11 days later) ... right?

I hope others will find this informative and better understand the link between the 2 STD's and the importance of getting tested for Syphilis -- cause it's makin' a big comeback.

I'm hoping my syphilis result is neg (along with my HIV) -- so please keep me in your thoughts.

Signed, Kinda Scared

Response from Dr. Frascino

Hi Kinda Scared,

1. Syphilis has had more comebacks than Cher, Madonna and Streisand combined. And just like The Rolling Stones and King Tut, syphilis is back on tour and drawing impressive crowds. (Even Brian on Queer as Folk had a case of syphilis this season!!! That means nearly everyone in Babylon's backroom is now at risk as well.)

Syphilis is easily transmitted through contact with open sores (chancres) on the penis, anus or mouth. Syphilis can increase the chances of contracting HIV, because chancre sores provide easy access for HIV to enter the body. The white blood cells at the site of infection (chancres or even "mucous patches" in the mouth) can also increase the chances for HIV infection. In your case no oral, "30 seconds tops" topping a dude whose HIV status is unknown and not having open sores or chancres I would not anticipate an increased HIV risk. Of course at this point we still do not know if your rash is related to syphilis or not.

2. A full course of PEP is 28 days. Is 11 days of PEP enough? No one knows. I assume it's better than no PEP, but not as effective as a full 28-day course in preventing an HIV infection.

I'll not only "keep you in my thoughts," I'll also send my best good-luck karma!

Dr. Bob

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