[Question #13490] Syphilis- unusual extra genital lesion
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3 days ago
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Question about an unusual skin condition that timing-wise is troubling to me. First, I was involved in a number of acts of MSM oral sex, both giving and receiving. I am on PREP, doxypep abd mpox vax. However, there was recently an outbreak in my area of mpox. After this, I noticed the bump on the sidewell of my nose, about a 1/3 of the way up the left side of my nose. Maybe 1cm up from the bottom of my nose. I admit I was touching it a bit. However, it started to grow, and then within another couple of days had turned a grayish color. It then started scaling. I touched it and a piece of it fell off. I had just taken some doxy at this time for another incident. It started to recede, and is now just a barely noticeable bump about 3 weeks later.
I had initial concerns about mpox but tested neg for that. However, now due to the timing I am concerned about syphilis. A day before I noticed the bump, I had a blotchy rash that occuring for 1-2 hours. It occurred while I was drinking and masturbating so at the time, I thought is was related to that. Now I am worried the blotchy rash and the bump were secondary syphilis. Most of the sexual events I am concerned about had occurred within the prior 6 weeks so I am thinking that may have been early for secondary syphilis. Then, started thinking of primary syphilis. There may have been some contact with the side of my nose during some of the acts. How likely is a chancre on the side of the nose (not by the nostril but up the side)? How likely is a skin lesion, bump that grows slightly and then scales and parts of it fall off within days, to be primary syphilis? Is the transient blotchy rash a concern for secondary syphilis?
I have quarterly PREP testing next month, just trying to decide if I should abstain until then.
Thanks.
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Edward W. Hook M.D.
3 days ago
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Welcome back to the Forum and thanks for your questions. I happened to be on the Forum when your questions arrived so you are getting a reply sooner than is typical. Follow-ups may take longer.
Congratulations on your approach to safer sex- the combination of PrEP, doxy PEP and the mpox vaccine will do much to keep you safe and reduce your risk for STIs. I too wondered about mpox until I noted that you had tested negative. I would believe that result.
While in medicine one can never say never, I have a high degree of confidence that what you are describing in not syphilis. Here are the reasons:
1. Location. I have never seen nor heard of a syphilis primary lesion on the nose. Remember that transmission requires direct contact and is promoted by abrasion. I'm guessing your encounters have not included this sort of contact.
2. doxy PEP is well over 95% effective for syphilis prevention
3. Neither a primary or secondary syphilis lesions would take a grayish color nor easily fall off with touching
4. Your blotchy rash was something other than syphilis- syphilis lesions and rashes do not come and go
So, what could this be. Without examining you I would not want to guess although impetigo, a common non-STI bacterial infection comes to mind. If the lesions is still present, I would see your doctor and ask but I am confident that this is not an STI.
I hope that this information is helpful. EWH
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3 days ago
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So in point 1, when you say transmission is promoted by abrasion, what exactly does that mean? Is it that a cut or open sore would need to exist for transmission to occur in that area? The thing is I can't be sure there wasn't direct contact with that part of my nose during the oral sex. However, I am pretty sure there was no open sore there.
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3 days ago
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My last question, since I have your attention. The 2 hour rash wouldn't be consistent with ARS either, correct? I am on PREP but my only concern (which was mild but still there) was that I had a couple pills in a hot car for about 5-6 hours when traveling so I was worried those pills were damaged and my protection may have been diminished during that time. I had oral sex the day after the car incident and I doubled up on pills so I still had 6 out of 7 for the week. So not too worried, until if course, there was the rash.
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Edward W. Hook M.D.
3 days ago
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Friction is a part of all sex. There does not have to be an obvious abrasion or open sore.
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a 2 hour rash in no way suggests ARS either.
I doubt that a few hours in a hot car would make your PrEP less effective
These are sort of "what if" and "could it be" questions. If you are really worried, just get tested and when the result is negative, accept it. Not trying to be harsh here but I think you are worrying far more than you need to be - you're doing things right!. EWH