[Question #4779] Erotic massage

27 months ago
Hello doctors,

I was recently in Japan on business and went to an erotic massage parlor. At the end received a handjob / mammory intercourse and the masseuse licked/kissed my right nipple for several minutes. She did not have any noticeable skin issues/ infections as far as I could tell.

About a week and a half later, I noticed that this nipple was more sensitive than the other and initially thought it was a friction/fabric irritation either from jogging or from the material of my shirt. However, this slowly progressed into what appears to be a generally dry, raised bump or series of raised bumps on one side of the nipple with shedding skin / maybe the appearance of plaque. The nipple sensitivity has continued and the lesion/whatever it is remains, additionally at times there is an intense itch. 

My main concern is whether or not this is syphilis. I've read through your responses on this site / medhelp and it seems that herpes is the only possibility here, but other resources indicate it could be syphilis. Are these symptoms indicative of syphilis and should I be worried? Can I continue unprotected sex with my partner? I am very concerned.

As this is on the rise in Japan I am very concerned that I have somehow caught syphilis of the nipple from what I always assumed was a perfectly safe activity. The dermatologist is booked out but I am hoping to schedule a syphilis test at 6 weeks from the event when I have my annual physical.

Thank you.
27 months ago
For clarification, the bump/lesion is on the areola.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome to our forum.  I'll do my best to help.  From a theoretical perspective, indeed this could be syphilis however if it is, it will be the first such instance that I have seen in over 35 years and evaluation of literally thousands of patients.  My suspicion is that the events and the irritation that you are experiencing are unrelated.  Having said that, with STIs, strange things do happen and the way to resolve them is through testing.  If the lesion that describe is syphilis, a blood test for syphilis at this time will be positive.  If it is not, you can be confident that the irritation that you are experiencing is not an STI. 
My recommendation is to have a syphilis blood test.  I expect it to be negative but far better to have test results than to worry.  I hope this is helpful EWH

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27 months ago
Thanks for your reply. So regardless of the 6 week testing period, if syphilis symptoms are present, the test would be positive? Should I test now or wait another 2 weeks for the 6 week window period to clear?
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Correct.  If this were syphilis, your blood test would be positive at this time.  While I am confident that your test will be negative, testing will prove this to be the case.  EWH---
27 months ago
I have not been able to schedule promptly with either my primary care specialist or a dermatologist to get a blood test, and I'm now noting a yellow-ish crust in multiple spots around the small area in question and the lesion or whatever it is seems to be somewhat more noticeable, although the itching has diminished. 

In the event that I do test positive, if I am treated and have not had any sexual contact with my partner between infection and treatment am I obligated to inform her? She may have briefly touched it with her hand. The continued presence/evolution of this is quite worrisome, will never stray whether "safe" or not moving forward. Apologies for the continued questions.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
No problem with your continued with your continued questions.  We provide up to three responses to each question.  OTOH, this is my 3rd response to your question and as a result, this thread will be closed later today.

  The crusting you describe would not be typical of syphilis.  Further, I would suggest that even if you cannot get in to see your PCP, you may be able to get a confidential, inexpensive syphilis blood test through your local health department- you could give them a call an inquire.

I would be flabbergasted if you turned out to have syphilis.  If you did however, in the absence of sexual contact in the interval, you would not need to notify your partner.

I hope my comments have been helpful.  I hope you will be able to work out testing soon.  EWH

 
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