Dear Dr Hook and Handsfield, I'm writing from Italy and I hope you will be able to understand my question despite my poor English.

Today I met a sex workers (in Italy they have any licence) and we agreed mutual unprotected oral and then protect vaginal intercourse.

We put in the classic " 69" position with her above. I briefly started to touch her clitoris with the tip of my tongue and I immediately noted she had a strange red round "pimple" (bump) between her vagina and anus. Due to 69 position clitoris was on the bottom and this "thing" on the top and I had no contact with it. I'm not a dermatologist, not able to recognize what it was and I found clever to stop my cunnilingus approach and have no intercourse. She only finished oral on me.

my questions are:

- odds that "thing" was syphilis or something contagious

- Odds to be infected without have certainly been in contact with it. (my tongue and mouth didn't certainly touch it)

- risks to resume sex with my regular partner

- your appreciate assessment and advice on this case

Some more information: She comes from east Europe. 23-25 years old

Because of my" hobby" I was tested last time on February for Syphilis (Igm Igg EIA, negatives) in May Hiv combo CLIA hep B C (although I had hep B vaccine last year),and throat swab for gonorrhoea. All negatives

In Italy STI experts should be the dermatologist (usually ID doctors give detailed advises in HIV only) but I discover you on me help before and here now. I read hundreds of your posts and I put 100% trust on your knowledge (far higher compared to what I found here)

I alrady imagine your assessment but I prefer to hear it directly by you....

waiting for your reply with my big respect for you both      

Welcome to the Forum.  I will try to help.  it is quite difficult to say what the lesion you noted may have been.  Syphilis, because of your description, because of the fact that your partner was a woman (most syphilis now occurs in men who have sex with other men), and because it is a rather uncommon infection, is unlikely but cannot be ruled out.  The lesion you describe could well have been a wart, a hemorrhoid, or a skin tag, none of which are infectious.  the only way to be sure however would be for her to be questioned and perhaps examined by a trained health care provider (i.e. dermatologist).  If it possible to locate her, I would suggest you ask her if she is aware of this lesion and if so, how long it might have been present.  If she is not aware of it, perhaps she would be willing to be seen by a dermatologist.

Equally importantly however, I note that you state that you did not have contact with the lesion.  If this is the case, then even if the lesion were infectious, it would be most unlikely for you to become infected- no contact, no infection.

From my understanding of your post, your risk for infection is very low and I would not be too worried about it.  Obviously however, as I said above, I cannot be completely sure of what this might be and if you want to wait to make sure that you were not infected, you will need to wait 3-4 weeks to see if a lesion develops (in this case, on your tongue) .  If no lesion at a site of contact, then you did not get syphilis from the encounter you describe.

I hope these comments are helpful.  sorry I cannot be more precise.  EWH

You have interpreted my opinions and advice correctly. 

I look forward to hearing a follow-up form you in a few weeks.  EWH

Dear dr Hook,

at today (3 and a half week around) I see anything on My tongue to "classify" as a lesion. The only thing from yestarday appeared on the top a very small White spot which sounds a normal oral canker sore. I use to have them very often, expecially in stress periods.

I'm not a doctor and I have no idea how a syphils lesion looks like. In you opinion might I confuse it with a Little White (i suppose) canker sore? Have I to show it to a dermatologist or in your opinion is it not necessary?

for my peace of mind (to certificate to myself I'm clean) I would like to provide a blood test. How long could I wait to perform it with a reliable result?

thank you for addressing me on this event.

I don't understand why, even if we agreed my exposure was really low risk (i'm aware of it) i'm feeling inside me like a non rational over reaction.

thank you for you comments

best regards 

I'm sorry that you continue to worry about your exposure.  The lesions you describe do not sound typical of syphilis.  Although syphilis lesions can be highly variable, they are classically open, painless sores which occur at points of sexual contact.  The best way to be sure that a lesion is not due to syphilis if there is a concern however is to have a syphilis blood test.  Such tests give reliable results after lesions have been present for two or three days and now, more than three weeks after your exposure, will be conclusive. 

This is my third reply to your question and therefore it will be my final reply.  this thread will be closed later today.  If you have additional NEW questions, you will have to create a new question however repetitive, anxiety driven questions seeking reassurance will not be answered other than to point out that this is what they are.  I remain confident that your encounter did not put you at risk for syphilis.  If you have a blood test at this time, please consider the results conclusive.  I am confident that if you have a blood test, it will be negative, proving that you did not get syphilis.  EWH