[Question #2051] Lesion appeared at day 35- syphilis concern

47 months ago
Iv asked a number of questions in the before and just as i was moving on from my incident i just saw a small cut/ lesion on my penis today which is day 35.

Just to recap - I had unprotected oral sex at a strip club for about 20 seconds. It was not my intention and i stopped it and walked out.

Dr Hook has explained to me i am at no risk for HIV . My tests for Chlymadia and Gonorhea were negative and therefore mostlyconclusive after 10 days. Doctor also explained to me i was at very low risk for Syphilis.

At day 28 my VDRL test was negative. In my mind i was learning to forget this incident.

However today on day 35 i noticed . Very small Painless lesion ( o.3 cm in length) on the foreskin of my penis. its a very small lesion but its there. It may have been caused by my nail when i was inspecting my penis but im not sure.  In the past as well

I went today once again ( as soon as i saw the lesion ) and got a vdrl test on day 35 . It is negative.

My question is 

1. Does the Negative VDRL test taken today on day 35( same day as i saw the lesion )  rule our that this lesion is not caused by Syphilis.

2. Do i need to test again for Syphilis in light of this particular cut/ lesion . If yes , when ?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome back to the forum. I have reviewed your previous threads. Thank you for your confidence in our services. 

I have to suspect your anxieties about a sexual exposure you regret are provoking unnecessary self examination. Based on this description, my guess is you would never have noticed the penile mark you are concerned about. You don't describe it in detail, but my guess is that indeed you are seeing a normal anatomic variant that has been their all along. In any case, syphilis would not cause this sort of thing. Finally, as you apparently have anticipated, your latest negative VDRL confirms you don't have it. You do not need to test again. Please note that my confidence (and Dr. Hook's) that you don't have syphilis isn't based only on the test result, but on the combination of several factors:  an exposure with extremely low risk for syphilis; absence of symptoms that suggest syphilis (well within the time frame in which a chancre would have developed), combined with the atypicality of the abnormalties you described previously to Dr. Hook and in this question; plus the blood test results. The possibility that all those indicators would break the "wrong" way, and that you nonetheless have syphilis, is infinitessimal -- zero for practical purposes.

Looking back on all your questions and our replies, I would encourage you to do your best to separate your anxieties about this sexual exposure and the medical consequences of it. They aren't the same. Deal with the former as best you can -- perhaps with counseling, if you find yourself continuing to dwell on it. But you really should not be at all concerned about the latter. Infection risk simply isn't a significant issue.

Those comments address both your questions. However, I am concerned you are becoming inappropriately dependent on our advice. We appreciate your confidence in our services, and I was especially pleased to see your offer to consider a substantial donation to ASHA (or perhaps other agencies) in support of STI/HIV research and prevention. Thank you. But please note the forum discourages repeated questions on the same topic or exposure. Among other things, we seek to reduce temptations to keep paying for questions with obvious answers, and experience shows that continued answers sometimes serve mostly to prolong users' anxieties Finally, you will understand that such questions have little educational value for other users, one of the forum's main purposes.

I hope this reply has been useful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

47 months ago
Dear Doctor Hunter

Thank you for your email.  You were right - its probably not syphilis as it has completely healed already. 

Also I do understand and respect what you are saying. Let me explain 

This has been by far the most traumatic experience of my life. I never intended that sexual exposure. I was taken to the bar by colleagues. Nobody put a gun to my head to go for a lap dance - but i went after a lot of peer pressure - Saying no ten times but finally said yes the 11th time. I didn't know what happens inside and I should have stopped it , but i stopped it only after 20 seconds of oral exposure. 

I have never felt so scared in my life. I told my wife the truth and she supported me. But in my fear i made foolish decisions. There was so much fear that i started peps. I went through it for 28 days. 

It has been made worse by the fact that i returned to India and there isn't an HIV physician who can guide me in my town. Hence i looked towards you and Doctor Hook for advise and guidance. I know i may have asked repetitive questions and perhaps crossed the normal boundary of questions. I apologise. It happened out of a fear that became deep rooted and overpowered me. My work and life has been greatly affected over the last 5 weeks. 

On day 28 I stopped the PEPs . On the same day I took a duo HIV test . I know the HIV test wasn't really required as suggested by Dr Hook but i took it for reassurance as you mentioned in your first post to me  . I also took the VDRL(also once again on day 35) , GONORRHOEA, CHLYMADIA  tests. All were negative. 

I am deciding to move on from this episode without any further tests. I want to stop thinking about this incident and freaking out with any small symptom  . I am going to make a large effort of putting this behind me . I hope I am making the right decision ? I am starting to work with a psychiatrist as well from tomorrow  as suggested by you for curing my anxiety and stress. 

I wont ask more repetitive questions as i understand that it beats the purpose of the forum. Thank you for bearing with me. As for the donations part -  I am lucky to be in a position where my company and I can both donate. While i move on from this episode - I want to donate to research (both to ASHA and other companies as well)  on HIV with a hope that one day in the future we will find a cure. 

Thank you for your advise and apologies for any inconveniences. Hope to be able to meet you some day. I think you and Dr Hook are amazing people . Good Bye 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
You are indeed making the right decision. Thanks for the thanks, and for considering a donation to ASHA. Best wishes.

47 months ago
OMG . 

Just when i decide to move on something bad happens . I really dont know why this is happening . I wish i could attach a picture . Since friday i have a large and very painful ulcer under my tongue . I waited 4 days before i ask anything because i didn't want to raise a false alarm . 

Its large , under the tongue with a white membrane and red halo around it . I am completely unable to eat because it hurts really badly 

I know its not Syphilis because iv tested negative at 6 weeks . 

I took an HIV DUO test at 28 days on the day i ended my PEPs. 

Do you think i need to retest for HIV ? I gave one today morning an HIV duo test but i dent have any results yet . 

Sorry to ask but i dont know what to do . Every time I'm trying to move on - a symptom from the list of ARS like a large  canker sore  shows up 


47 months ago
I just got my hiv duo test as mentioned 4 hours ago . Its day 16 post stopping peps 

Its negative . VDRL is negative 

I have no idea what has caused such a large ulcer. Its painful.

The local GP says its caused by stress but he also says he doesnt know enough about HIV to comment .

I have been taking mental therapy trying to move on  and manage the stress and anxiety. This ulcer has thrown me off all the progress i made trying to move on.

I assume my negative hiv duo test has shown that this large ulcer is not caused by HIV ARS because the antigen test would have come positive by day 16 if this were caused by it. 

Week 6.5 post exposure and 2.5 post stopping pep - HIV duo test is negative. ( insertive oral only with a very small lesion on penis) 

I am once again going to try to move on without further tests. Trying to focus on therapy to move on .
47 months ago
I forgot to mention the pain under my chin - seems to be below the ulcer . 
Its probably a lymph node. It hurts everytime i look down and everytime i press it.

I just cannot understand this painful large ulcer and this pain under the chin .
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
You're right, this cannot be syphilis from the exposure described. And a single mouth ulcer (or any mouth ulcers at all) are never a sign of HIV; oral ulcers with HIV are never the only manifestation. I agree the pain under the chin probably is an inflamed lymph node as a result of the ulcer. My guess is you have garden variety aphthous stomatitis (canker sore). I am confident this has nothing at all to do with the sexual exposure you are concerned about. See your doctor if it continues.

47 months ago
Thank you for your mail doctor. So i assume no more testing is warranted for hiv and I should try to move on with a therapist for anxiety ? 

As far as the ulcer is concerned- i understand from my local GP it should probably heal itself .

Trying to move on now
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
For sure no more testing is needed.

As I believe you know, the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, and your fears about HIV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them--which I think may be the case for you. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

Best wishes to you.