[Question #5111] Syphilis rash concern

26 months ago

Hi,
In early Jan. I had an encounter with a FSW. It involved receiving oral and intercourse and both were fully protected with a condom. A few days later (week at most) I developed a pink bump on the shaft  of my penis near the base... looked like an ingrown hair. I kind of squeezed it after a day or two and it broke open and bled a bit. It left a tiny wound about 1mm by 2mm that healed overnight to just a bump again. Based on the timing and the fact that I had recently shaved in this area, and being  99% sure this area was covered by the condom, I wrote it off as an ingrown hair. The bump stayed around for about  two weeks, sometimes barely visible, sometimes reddish. None of that is odd. I'm prone to body pimples.

Then a few weeks ago, roughly 8 weeks after encounter, I developed a pimple outbreak in the hair follicles on my inner legs where my they often rub together.  Starting at my knees it goes 1/3  up my inner thighs on both legs. They appear as tiny red pimples, about 1mm in diameter with an initial pink halo that goes away after a day or so. They have "heads" and are "poppable". They tend to heal after a few days into tiny darker spots that slowly fade, although new pimples appear every few days.  This also developed while I was exercising a lot and not always showering right after...so I thought some type of irritation. However, it is still there and I get 1-2 new pimples every couple days. Based on the timing I'm winding myself up into thinking this could be syphilis. 

Am I overthinking? From what I've seen online the pimply rash is not typical of syphilis. It's not flat/patchy. Except for a few stray pimples elsewhere, it is contained to the area where my legs rub together. Nothing on hands, feet, or back, etc. Also, after the rash showed up I took a 1 week of penicillin for an abcessed tooth. 500mg 3x a day for a week. I don't know if that would be enough to offset any concern even if I had contracted an STD (didn't cure my "rash").

Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back to the forum. Thanks for your continuing confidence in our services.

This event, in partcular the genital area pimple, seems quite similar to the one that first brought you to the forum over a year ago. As we discussed then, this doesn't sound atall like syphilis. The same is true of your apparent follliculitis, and you are exactly right:  although the skin rash of secondary syphilis is highly variable, it probably never includes sequential pimples or anything resembling folliculitis. Also, the penicillin would have very promply (within 2-3 days) cleared up the rash if it were syphilitic.

If you acquired syphils in early January, a blood test at this time would be positive. The penicillin could have been a complicating factor if you had taken it earlier. But if not started until 4-6 weeks after the sexual exposure, you still would have had time to develop a positive blood test. Fom a strictly medical standpoint, based on the exposure and your symptoms, a syphliis blood test is optional. However, many persons worried about particular STDs are more reassured by confirmatory lab testing than by professional opinion alone, no matter how expert that opinion. If you decide to be tested, you definitely can expect a negative result.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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25 months ago
Hi Dr H,

Thank you for your reply. I appreciate it. I thought I was being too nervous about it, but most of the "instructive" information available on the internet seems to bounce between "Syphilis would have these very specific symptoms" to "essentially any bump or rash could be a sign of syphilis". This tends to apply to most STI's, so knowing when to see the doc is often a tough call, especially if you're a "what if" type of thinker. 


I appreciate the reassurance and I'll wait and get tested as usual during my annual checkup as always.

If you don't mind a follow-up question for educations sake, I'm a little confused by the testing parameters you mention, specifically regarding the effect of the antibiotics. I understand 4-6 weeks would be enough time for a test to come back positive. However, it would still be positive now even after taking 1 week of penicillin? Even though the penicillin would be enough to clear up the rash quickly? Just a little confused by that.

Either way, thanks very much. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Although true that you can find pretty much anything you want on the web, when it comes to STIs (and most health problems, actually), you can limit misinformation by sticking to professionally run and moderated sources such as forums like this, sites of academic and public health institutions, etc, and entirely avoiding those run by or for persons with the problem itself or with a product to sell.

It takes several months for the RPR and similar "non-treponemal" syphiis blood tests to become negative with treatment. And many of the tests now used most commonly (e.g., various ELISA and IgG/IgM tests) remain positive for life, whether or not treatment is given.
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25 months ago
Thank you.

One last general question-

If a test remains positive for life, how do you know if you’ve been cured of the infection, or in the future, if you’re testing positive from the old (cured) incident or a new infection?

Thanks in advance and I’m done now!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
For exactly this reason, diagnosing recurrent syphilis sometimes is a challenge. Symptoms and physical examination often are helpful. Also, the strength of the non-treponemal tests (RPR, VDRL, etc) varies with disease activity, so conversion of that test from negative to positive often indicates new infection; as does an increase from, say, a titer of 1:4 to 1:16. Other tests, such as lumbar puncture to examin spinal fluid, sometimes must be done as well.

That concludes this thread. I hope the discussion has been helpful.
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