[Question #11199] Syphilis Sore and testing

16 months ago

A week ago I noticed a reddish blemish or bump on my right side of my penis head close to “the rim.” (if I’m looking down at it it’s on my right) It seemed to get worse after masturbation or showering with hot water. No pain or puss.

I tried taking pics and in the pics it looked like a raised bump. In one pic it looked like it had a dry skin rim around it. Another pic it looked shiny. It looked different depending on the lighting and angle.

The next day I went to my PCP and he thought it was a gland irritation from friction. He didn’t think it was syphilis.

2 days later, I went to my urologist for another reason and decided to show him as well. He didn’t think syphilis or STD either. He thought it could be friction and fungal. So he gave me Clotrimazole 1% cream twice a day. It’s pretty much gone now a week later.

On the 3rd day I did get a Syphilis RPR blood test. It was negative.

My background, I’ve been with the same woman for 2 years and I have been tested 4x for the “big 4” since I’ve been with her that past 2 years. All negative. Always use condoms. (I have HSV2 and genital warts at times and she knows)

So I’d have no real reason to get syphilis.

1) IF it was syphilis, wouldn’t the test be positive since there was a symptom?

I remember you saying you can’t have symptoms and a negative test on this forum.

2) Can you get Syphilis or Gonorrhea Chlymida through cross contamination such as shaking someone’s hand and then touching your penis? Does it even work that way?

Thank you!

H. Hunter Handsfield, MD

16 months ago

Welcome back to the forum. It's been a while!

All in all, I agree you "have no real reason to get syphilis"; or even to suspect it. Having had no new partner, and apparently no reason to suspect she has been at risk for syphilis (or you would have mentioned it), you were not at risk -- on top of which you describe consistent condom use with your partner. And the spot you describe doesn't sound at all like a chancre, i.e. the lesion of new syphilis, and two doctors already agree. To your specific questions:

1) "IF it was syphilis, wouldn’t the test be positive...?" Not necessarily. The blood test is positive in about half of people with syphilitic chancres. Once the chancre is present for 7-10 days, almost all would have positive blood tests. So this aspect doesn't say anything one way or the other about syphilis as the cause of your penile bump. (The previous statement you quote obviously was not in relation to primary syphilis.)

2) No STD ever is transmitted by such non-sexual contact. Zero risk for sure.

All in all, I don't recommend any further testing; there is no realistic possibility you have syphilis. However, I understand the potential value of negative testing, which often is more reassuring than professional opinion, no matter how expert. (We don't take it personally!) If you would sleep better having another negative test in a few days, feel free. (This does not mean I believe there is a chance you have syphilis. I do not.)

Final advice, reacting both to this question and at least one of your past ones, when you asked about a penile lesion and herpes: Do not assume that genital skin problems are likely to be STDs. The large majority are not. I have a book, Genital Dermatology Atlas; as the name implies, it is filled with photos and brief descriptions of genital skin problems. All STDs are covered in just 15 of its 300 pages. And you certainly should not be concerned about STDs when you obviously have not been at risk!

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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16 months ago

Thank you for responding. This is a great resource for general questions. Your book you mentioned sounds interesting..

Sometimes when you take pictures with a cell phone, even though the quality is quite good, the lighting or angle can shape the way it looks. My urologist saw the pics and said the red bump and then I showed him in person and he came to the fungal diagnosis.

I asked this question because I stumbled on an article that stated non-sexual ways of getting syphilis, gonorhea or chlamydia and how long the bacteria from those STDs can stay alive on surfaces. (It’s why I brought up shaking a persons hand and then touching your penis, or if your penis touches the inside of a toilet from going poop etc) I’m guessing you have an evidence that is not true?

H. Hunter Handsfield, MD

16 months ago

It's hard to safely critique a resource I haven't seen. It is well known that STD bacteria and viruses can survive on environmental surfaces for a while, but there has never been a proved (or even suspected) case acquired through environmental contamination or contact. The busiest STD clinics never see infected patients whose potential exposures did not include the traditional sexual exposures -- i.e. none whose only stated risk was contact with blood or genital fluids on toilets or elsewhere in the environment. Certainly no such case ever came to my attention in my 50+ years in the STD business. ---
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15 months ago

Ok thank you for putting my mind at ease.

So you can’t catch it except through sexual contact. Prolonged sexual contact. And I’ve been with the same person for 2 years who’s negative. So I’m good.

15 months ago

I meant to add regardless of what the pics looked like. And the two DRs who thought it WASNT STD related. I should be good. It’s hard to tell my mind that. lol although I am in therapy

H. Hunter Handsfield, MD

15 months ago

Sexual contact indeed is required, but don't necessarily have to be "prolonged".

I agree you are all "good", for the reasons you state yourself. You should not be remotely concerned about syphilis.

Best wishes and stay safe.

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