Hello Dr.,

I briefly performed unprotected oral sex (1-3 minutes) on a CSW in Germany three weeks ago and have developed a concerning sore directly below my bottom lip (the top of the sore just touches the lip).  The sore emerged 17-18 days post exposure and I picked at it quite severely with my finger and tooth (through anxiety).  The area then developed a crust and dry skin.  It is now three days since it appeared and it doesn't seem to be improving.  It is circular, raised and I think the center is slightly dipped (it measures probably around 5mm across).

I have read extensively on the topic and feel like it is displaying many of the signs that routinely accompany syphilis.  I did have screening for chlamydia, gonorrhea (throat and urine) and syphilis (blood) at 14 days - all of which came back negative. 

I was hoping you could offer your opinions on my symptoms.  I have seen previous comments (both here and Medhelp) that vaginal>oral transmission is very rare, but my anxiety is terrible right now over this.  Also, is it a common site for the sore to present and when I read that a chancre is usually an open sore, what does this mean?  Given the location of the sore if it was syphilis, am I likely to have passed it on through kissing (not deep kissing, pecks on cheek / lips etc.)?

Thank you so much for your time and the advice you provide in what is a very stressful situation for all those seeking your insights.

Regards.

Welcome to our Forum.  I'll be glad to comment but what I think you need is re-evaluation by a trained expert.  You summary about the rarity of oral chancres is absolutely correct and facial chancres would be even rarer than oral chancres which most typically are found within the oral cavity.  Typically blood tests for syphilis become positive within a few days of the appearance of a lesion so that a repeat blood test would be a great place to start in your evaluation.  In addition cultures for strep (not an STD but a common cause of such lesions), a PCR for herpes, and evaluation for a possible fungal infection are reasonable as any of these could cause the sort of lesion you describe and are more likely causes than syphilis. 

If this were syphilis (or for that matter most of the other infections I mentioned) transmission could occur from direct contact but not indirect or just close contact such as a kiss on the cheek.

I would be surprised if this turned out to be a syphilitic chancre but I understand your concern.  Seeing a dermatologist might be a good place to start.  EWH

Many thanks for your response - it has definitely gone some way to allaying my fears.  I have already booked a blood test for tomorrow and a follow up with a Doctor too.  In the meantime I was wondering whether my description sounded consistent with a syphilis chancre?  I know trying to make assumptions via the internet is a fools errand, but from what I have read you say before the crusting and dryness of this lesion are not the normal presentation - with an open sore (which I interpret to mean wet or smooth) as opposed to crusted like mine.  My concern is that given its location, even an open sore would crust like this...  

Thank you again, your advice has been greatly appreciated.

Just wanted to follow-up based on my appointments yesterday.  As discussed, I went to see the doctor and was examined again. By the time I visited the crusting had come away from the bump below my lip and the skin underneath was pink and a little shiny. I explicitly asked whether it looked like a syphilis sore and the doctor said it didn't and that it could really be anything. He then took bloods (22 days post exposure and  4 days since the sore appeared) the results of which came back today as negative. He also offered to do a swab of the sore, but as there was no moisture to it, it was mainly of the skin. I am still awaiting that result.  He also said that given my exposure, he probably wouldn't have even suggested a blood test for this incident alone and would normallly have just recommended I waited until a regular screening as a sexually active induvidual.

With this information, and given the time passed from the potential exposure (22 days) and appearance of the sore (4 days), do you think I need to test again or can I take this as relative reassurance that this wasn't syphilis?

As I know this is my last response, I would also like to thank you for all the time and information you give online.  When gripped with anxiety and worry, it is often difficult to determine what constitutes valid analysis amongst the myriad of voices on the internet. The work you and your colleagues do is genuinely helpful to those in difficult situations and allows a trusted resource. Thank you again. 

Thank you for the follow-up information. Your doctor had the advantage of being able to see the lesion of concern but his assessment is similar to the direction I was going.  With this passage of time, I really no reason for continuing concern, for additional testing of any sort or for concern that you might have caught something that you could give to another person.  It is time for you to move forward without further concern regarding this lesion or your recent sexual exposure. 

Thanks as well for your confidence in our services.  It is our pleasure and privilege to be able to help.  As you point out, this thread will now be closed.  EWH