I have a question about a possible syphillis symptom, exposure and testing.

21 days ago i recieved brief, unprotected oral sex from another man, and this is the only sexual activity that i had this year.

Fast forward to yesterday:

While masturbating I felt a sort of friction burn pain on the upper side of the penis (on outer, upper foreskin somewhere in the center of the penis)

I noticed like a tiny raised area not perfectly round (~4 -5 mm) that had a hard dark coloured scab ln its center. That tiny scab fell of while i was showering later that evening. 

Today the skin change is pale in contrast to surounding skin (like it has chaffed off on that little area) and it does not hurt nor ooze. When i touch it it feels just like surrounding skin and its not hard. It seems that it hasn't grown since yesterday, and I'm pretty sure that skin change was not there 2 days ago.

 So, I would like to ask you if this does sound it could be primary syphillitic sore? And if so, when should i go for the blood test considering my exposure was 21 days ago. 

The test would probably be TPHA or TP-EIA.  

To mention, I have never had any such skin changes on penis. 

Thank You in advance!

First, oral sex is very low risk for syphilis; and although you don't say what you mean by "brief", short encounters are even more unlikely to transmit syphilis. Even if your oral partner had active syphilis involving his mouth or throat, you were at little if any risk. Second, your symptoms and the appearance of your penile skin do not suggest syphilis. My guess is that whatever irritation there was resulted from your masturbation and had nothing to do with the BJ you received 3 weeks ago. I have to believe that much of what you describe reflects enhanced awareness of your penile skin because of anxiety about syphilis; they may even be normal variations in skin appearance. Or conceivably mild exzema or other skin irritation, but not syphilis.

From a medical/risk standpoint, I see no need to be tested for syphilis. However, you are free to have a blood test if you would like the reassurance of a negative test result. At this time, a negative result would make it very unlikely your symptoms are due to syphilis. You could then have a truly conclusive blood test in another 3 weeks, i.e. 6 weeks after the sexual exposure.

In the meantime, if your skin symptoms continue, consider seeing a doctor -- ideally an STI specialist or dermatologist. From all you have said, you can expect additional reassurance against syphilis.

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

HHH, MD

What was the condition or diagnosis of the second image you attempted to show us?

As you predicted - my results are negative at 3 weeks (TPPA) and 5 weeks (TP- ECLIA).

The reason why i tested at 5 weeks (almost 2,5 weeks after the skin change appeared) intead of 6 is onset of the following symptoms 2 days prior to 5 week testing: malaise, feverish feeling, cervical lymph node(s) pain, viral exanthem like rash on my chest/abdomen), irritated throat and "burnt tongue" feeling that is not going away for days. (Covid negative)

The specific skin change i mentioned earlyer healed with hypopigmentation. It lasted for ~2 weeks. It didn't look  like classic primary chancre (from what I saw online). 

I contacted the man I met with and informed him about the situation. I learned that he had syphilis treated in the past, but hasn't been tested again for it since ~12 years ago. (He thought he had protection from it due to antibodies......) He will get tested next week.

Questions part:

1. Is there a need for me to retest at 6 weeks or at any other time given the current situation? 

2. Can my symptoms point to the start of the secondary phase?

3. If this is indeed syphilis, is Doxycycline a good alternative for someone that always has adverse reactions on antibiotics like amox?

Thank You.

2. You cannot have secondary syphilis so soon after exposure or with a negative blood test.

3. Doxycycline is highly effective against syphilis; It's the treatment of choice when penicillins cannot be given. Doxycycline allergy is rare and having reacted to penicillins does not increase the chance of a reaction to doxy. But it would be dumb for you to take doxycycline anyway in the current situation. Don't do it.