[Question #5140] Herpes/Syphilis question

23 months ago
Hi Doctors -On 3/8,  I had protected intercourse with an Asian Sex Worker.   My typical reaction when I do these things is to go over everything in my mind and think about every possible risk.

I immediately started thinking that I could have picked up Crabs, and after reading some posts on this site decided to cut my public hair to a short length so I could easily inspect myself over the following week.  The crabs haven't shown up but I continue to check myself and have noticed every itch and sensation.   The reason the crabs thing got in my head is that she had a lot of hair in the public area.

During my daily inspection yesterday, I noticed a pimple-like bump in the hairs just outside the fold where the penis and scrotum hang.  This is an area that was not covered by the condom about an inch away from the bottom of the shaft, just outside the area where the penis and scrotum area.  It is painless bump, looks like raised skin with no head or puss.  It is red, seems scalely and really resembles a pimple or ingrown hair.  However, as we all know, we can find a lot of info on the internet that lead us to suspecting the worst case possibilities.   It seems that people, and even doctors, have trouble differentiating pimples and ingrown hairs in the grown area from herpes and syphilis lesions.

I understand that this could be a herpes lesion or, potentially even syphilis.  I've been tested after similar encounters over the years and have never contracted anything but I've never come upon a bump in those scenarios.

I did cut my public hair very short with a scissor on 3/9 and think that may have made it more likely for an ingrown hair.  Also, I've always had long public hair as did the individual who I had the encounter with ....  my sense is the hair would provide some form of barrier from an exposed lesion if one were present.

I know the only way to know for sure that this is not herpes or syphilis is to get tested but I wanted to see if you have any thoughts about it.

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome to the Forum.  I'll try to help.  you've done a good job with your own analysis and, as you point out, the best possible way to determine what this lesion might be is to get tested with a swab test (preferable a PCR) for herpes virus.  My suspicion is that what have noticed is folliculitis from your description and the fact that you cut your pubic hair which may predispose you to folliculitis.  The other possible non-STI cause of this lesion would be a cyst of the sort that is not uncommon on the scrotum.  Several other comments which may be helpful to you:

1.  Please do your best to avoid repeated manipulation and self-examination.  the things I am about to describe will be obvious if they occur.  No pushing, squeezing or scratching please.  If this is folliculitis, the lesion may appear as a pimple- I still would not squeeze it.
2.  Syphilis is a relatively rare infection. If this is syphilis, in the next day or two, the bump would enlarge and then form an open, ulcerative sore.
3.  If this lesion were herpes, I would expect multiple lesions not a single one.
4.  The location you describe would be an unusual location for either syphilis or herpes- the majority of lesions for both infections when they occur on the penis occur near the head of the penis.
5.  Being aware of the lesion will likely lead to you feeling that the spot "itches".  This is typical for any part of the body that a person concentrates their attention to and does not mean that this is either syphilis or herpes.
5.  Please do not take antibiotics, this will just confuse things.
6.  As noted above, sooner than later please seek evaluation by a health care provider who has access to PCR swab tests for herpes.  (Some emergency rooms and walk-in clinics do not).
7.  If this were syphilis, after another day or two a blood test for syphilis would likely be positive.  OTOH, PLEASE, PLEASE DO NOT get a blood test for herpes.  It is too early for a reliable result and there is a substantial possibility that you would have a falsely positive test.

As I said above, from what you have described, it is more likely than not that this is not an STI.  Just trying to provide as much information as possible.  EWH
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23 months ago
Hi Doctor -  Thanks for your reply.   Some follow up questions.....

1) The swab test (preferable a PCR) for herpes virus. - You wouldn't recommend a blood test at any time?  I usually get a blood test through a service affiliated with a lab.   
2) If this is syphilis, in the next day or two, the bump would enlarge and then form an open, ulcerative sore. ---  So, if things remain as is and the bump doesn't change to the  open, ulcerative sore form .... The likelihood of this being syphilis is remote if not nil.  Is that a fair statement?
3) The location is just outside but close to the penile/scrotul area ... not on the scrotum ....its in the upper skin that surrounds the bottom of the penis.  very close to the fold where the shaft begins.  --- sounds like with these infections they are mostly on the penis 
4) I'm not planning to test right now for either infection ....  I'm going to refrain from sexual activity with my partner for a few weeks and see how this plays out.  Any thoughts on that idea?
5) Seems as though the view from the doctors here is the following: Syph is very rare and  to acquire it based on the circumstances I've described would be extremely remote.  Possible in theory but probably better chance of other tragic circumstance befalling me vs getting Syph based on probabilities.
6) Finally ....  Both Syph and Herpes would have very clear cut characteristics ...  Herpes: Multiple legions not quite resembling a pimple/ingrown hair.  Syphilis: A lump that would grow larger and open up.

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
1. the blood test for herpes is prone to false positive and may not be positive until 4-6 months after the onset of infection.   It is not useful for early diagnosis.
2.  The likelihood that it is syphilis is low.  If it does not change as described, the likelihood the lesion is syphilis is virtually nil.
3.  I understand the location.  Your statement is correct.
4.  I think you will still be wondering.  Negative tests will help to avoid it.  
5.  Correct.
6.  More or less.  Part of the reason we test is because both diseases can be variable in their appearance.

Not sure why you are resistant to testing.  Seems as though negative test results might be reassuring.  EWH
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23 months ago
Hi Doctor -  

I am not against testing at all.  However, due to complications with insurance and the need for confidentiality, I prefer to use the lab service I've used in the past which provides a blood test.  To get the test you describe, it sounds as if I need to do research, find the right facility, which in my past experience isn't in good neighborhoods or easily accessible.   

Since the probability is likely not high based on what our correspondence, I feel it's reasonable to  continuing to watch for symptoms in the short term and then get tested in a timeframe which would likely offer an accurate result.   I will definitely get a test in the future.  Do you think this is reasonable?

Thank you!

Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Depending on your location, high quality testing can be done inexpensively at a number of U.S. public health clinics. They are high quality, inexpensive and confidential (including not necessarily billing one's private insurance).  At the same time, I do acknowledge that the likelihood that the lesion you describe is an STI is low and of little concern and, as long as you are comfortable, should not be a problem.

As you know, we provide up to three responses to each client's questions. This is my 3rd response as part of the thread.  Thus this thread will be closed later today without further responses.  Take care.  EWH  
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