[Question #3050] Is this syphilis?
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92 months ago
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About 10 weeks ago I had protected intercourse with an escort. Roughly 8 weeks later, I felt what seemed like an ingrown hair in my abdominal pubic hair 2.5 inches above my penis (not on it). Stung a bit but not bad. I get those sometimes around wear my pants sit. No big deal.
Then some days later (10 days ago), the "ingrown hair" burst one night to my surprise while I was using the bathroom (I may have scraped it), leaving a watery crater about 4mm in diameter with rounded pink edges and a whitish center. It didn't sting or hurt unless I touched it. By the next morning it had flattened out and skinned over, seeming pink brown and dry with a bit of dark red around the edge. It proceeded to scab over and over the next several days shrink slightly in diameter every night. I accidentally scratched off the scab one day, and it bled then wept clear fluid for a few minutes, then scabbed over again and continued to shrink. After 10 days it's fully healed, except for some pinkish skin in the area. It ached a minuscule amount at times but not much. It never seemed hard and after the first night never seemed raised at all. It mostly seemed dry...certainly not weeping except for when I pulled the scab off.
Does this sound like syphilis? There is so much contradictory info online about incubation and healing times, as well as the nature of the chancres that I'm not sure if I should be concerned or not. I don't want to be crazy about it, but also don't want to risk passing anything along to my usual partner.
Thanks.
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H. Hunter Handsfield, MD
92 months ago
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Welcome to the forum. I happened to log in a few minutes after you posted your question: most users should not expect nearly real-time replies!
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This doesn't sound at all like syphilis. The location is wrong: the organism must be massaged into tissues for infection to take, and therefore syphilitic chancres generally occur at sites of maximum friction during sex (penis, labia in women, etc). The timing is wrong: chancres appear within 4 weeks, maybe 6 weeks, but not 8-10 weeks. Third, a chancre would not start at a hair follicle or otherwise look like an ingrown hair. I suspect you are focused on the "crater" aspect, but that can happen with any localized skin infection. Finally, an escort (i.e. expensive female sex worker by appointment) is very unlikely to have active syphilis. Indeed, most such women are believed to have low rates of all STDs: their clients typically are low risk (men like you!), they know how to protect themselves, and are tested frequently.
So you really needn't worry at all. That said, you certainly could have a syphilis blood test if it would increase your confidence about it. Sometimes a negative test is more reassuring than even the most expert opinion based on probability and statistics. But it's up to you -- if somehow I were in your situation, I wouldn't do it.
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
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92 months ago
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Thank you Dr Handsfield. I understand this is 99% not syphilis.
May I ask some clarifying follow ups just for my own health education?
Does the pre chancre papule "pop" like a pimple or blister or does it degrade into a crater?
When they say a chancre is wet, is that just at the outset or does it stay wet and weep for the average 3 week duration, then start to heal?
Do chancres scab over and heal by shrinking in diameter like ingrown hairs do? Or do the sort of "heal in place" so to speak?
Are there ways lay people such as myself can differentiate between a chancre and something like an ingrown hair or other non sti skin issue?
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H. Hunter Handsfield, MD
92 months ago
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These questions reflect significant overthinking. Please note that I gave several reasons this isn't syphilis. The appearance of the lesion is probably less important than the others -- but together they add up to 100% certainty against syphilis, not 99%. I did not recommend testing because I think there is any chance you have it, solely for reassurance if you think it will help you stop worrying. Syphilitic chancres are highly variable, but the papule generally lasts only 1-2 days before it erodes, without "popping" like a pimple; it would not scab over and probably would usually "heal in place". I've already stated most of the ways you can be certain this wasn't syphilis. Chancres generally are painless and often quite firm and nontender. Beyond that, I would suggest you google syphilis photos, or chancre photos in particular, to see typical examples.
Let this go. You don't have syphilis.
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92 months ago
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Thanks Dr Handsfield. I did believe you. But my internet reading prior to asking here left me with some general curiosity, which you've answered.
Thank you.
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H. Hunter Handsfield, MD
92 months ago
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OK -- sorry for my own overthinking in interpreting your follow-up questions!---