[Question #3945] Syphilis testing

34 months ago
Hello, 
Thanks for taking our questions. 
About 10 months ago, I developed a small about 1 inch long less than half wide area of redness at the base of my penis. It was about 20 days and also three days after I had sex with a new female partner. I wore a condom for vaginal sex. I did not for oral sex. 
The area was not raised or ulcerated. It was not round, it was more like a thin straight line. I had gone for an intense bike and run on a hot day in cotton underwear and the underwear bunched up and the line was roughly the same width of the seam. 
The area healed completely within a few days and left no scarring. I did not get antibiotics. 
By the time I could get in to see my physician it was basically gone. 
I had a negative RPR about 4.5 weeks later so 8 weeks after the first sexual encounter and about 5 weeks after the second. I also had a negative RPR done at a recent visit. All of my other tests including HSV1&2, HIV were negative with the HSV1&2 at 16 weeks post the last exposure. 
My doctor said that the area healed too quickly and did not sound at all like it was a chancre based on descitipion. He said it was possibly the right timing from the first exposure but not the second. He said that even before testing it was unlikely syphilis. After testing, he said it was ABSOLUTELY NOT syphilis and suggested no further testing. He thought it was likely just irritation from my underwear and nothing more. 
Would you agree with that reasoning? I have read that occasionally there can be false negatives in primary and latent syphilis with the RPR and that other tests are more sensitive. Would you suggest I have any testing other than the RPR?
Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
 Welcome to our forum and thanks for your confidence in our advice. I agree completely with your doctor.  You have a good, non--STD reason for the lesion you noted and negative tests at a time when they can provide accurate information. You do not have syphilis.   On an average the ulcers associated with Syphilis occur about three weeks after sexual contact. Thus your lesion occurred at a time when Syphilis might have occurred relative to your first contact but not the contact that  was closer in time to the appearance of the lesion.  Without treatment however syphilis lesions would persist for several weeks and an RPR test would be positive within a few days of the appearance of a lesion. Your negative RPR test proves that you do not have syphilis.   The rare problems that occur with the falsely negative RPR tests occur at about the same time that lesions appear (within a day or two) and in persons who take antibiotics. Neither of these has occurred with you. Believe your results. . There is no need for  additional testing and no need for concern. My advice is to put this experience behind you and move forward without concern. EWH. ---
33 months ago
Thank you Dr. Hook. 
My other lingering concern had been for herpes. As below I had negative igg testing at 16 weeks. Because I was still worried I had a repeat test at 6 months and my doctor also sent a Western to University of Washington.  It was negative too. 
Maybe 4-5 times, I've developed these very small areas of redness on my penis that have mostly lasted less than a day or two. Never had any blisters, ulcers or sores over the 11 months. My doctor let me swab at home twice and sent those areas for pcr and it was negative both times. He basically said that that was enough and there was now 0% chance I had herpes and that I should not pay attention to the areas of redness unless there were clear blisters or sores which there would not be. Would you agree with that approach?
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
 Once again I am agree entirely with your doctor. The testing you have had entirely rules out the possibility that the rash you describe was herpes. It sounds like the process may continue to recur and, if it is troubleshoot then I would see a dermatologist to get assistance in alternative, non-herpes, non- STI diagnoses. I would not worry about herpes going forward however.   EWH---