[Question #232] Syphilis or not?

36 months ago
Hi, Doctor(s)!
I've been having sensual massages for few months at a special studio with one and the same person.
This practice does not involve vaginal, anal or oral sex at all. It is reduced only to an intense touching (rarely hand-to-genital contact), rubbing torso against torso, kissing certain body parts - face (except mouth), breasts, back, and hands. Fluids are not being exchanged for safety reasons. Occasionally, there might be some traces of saliva or sweat on my skin due to the close contact. 
10 days ago I noticed a red lesion/lump in my lower back just above the bikini line. My dermatologist said it could be a cyst.
He was not aware though of the possible exposure. I am still so afraid it could be a syphilis chancre, despite the fact it does not look like an open sore. Based on the information provided, could you unambiguously conclude whether or not I am at risk for syphilis? Thank you!

Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to the Forum.  I'll try to help.  Syphilis is transmitted from person to person through direct contact of an uninfected person with a syphilitic lesion and does not necessarily require penetrative sex or fluid exchange for transmission.  Thus, I suppose that if your masseuse had a syphilitic lesion somewhere which came into contact with your skin in the course of your massage transmission could occur.  When a syphilitic lesion occurs, rather quickly (in a few days) it progresses from a intact lesion to an ulcerated, open sore,  Syphilis lesions are also typically painless.  If your lesion is not doing this, it seems unlikely.  Further, unless there is more to the story in terms of what you know about your masseuse or the contact, the scenario you describe however seems a bit unlikely and I suspect there are many other dermatological processes that could be causing this problem. I am surprised your dermatologist did not offer a better explanation - it might be worth mentioning your concern to him.   If the lesion has been present for more than two or three days, a syphilis blood test would certainly rule out the possibility of syphilis.

I hope this comment is helpful.  EWH

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36 months ago
Thank you for your answer!
I spoke to my masseur and explained all my concerns. He said he got tested a short time ago and he had nothing (he is regularly checked for sexually transmitted infections, because the nature of his job requires him to establish a safe environment for his clients). As for my dermatologist, he looked at the lesion and immediately concluded it was a cyst, but he had no knowledge of my eventual exposure. I myself observe this spot every day, and it still looks like a small sac, which is not letting out any matter;  it just holds some fluid deeply under the surface of the skin.
If it is syphilis though, can I pass it to a family member and how? Can I still have protected sex without allowing my partner to touch the spot?
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
The more  you describe, the less likely it is that this is syphilis.  You did a good thing to speak with your masseuse- that should help to put your mid at rest.  Even if it were syphilis, your family would not be at meaningful risk. Syphilis is really only transmitted by DIRECT contact associated with at least moderate friction.  It is never transmitted through clothing either.  You can certainly have protected sex with your partner and not have any concern that you might be passing syphilis to them.  Personally however, I would urge you not to worry further about syphilis.  If you are having a hard time shaking the idea, then get a syphilis blood test and put the possibility away once and for all.  EWH
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36 months ago
Thank you so much, Dr. Hook, for taking the time to answer my questions!
You were of great help to me! 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Thanks for your thanks.  We are pleased to be able to help.  EWH
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