[Question #5442] Syphilis or?

74 months ago

Hey docs, my situation described below:

- I had protected vaginal and unprotected oral sex with a high-end CSW (white, female, in 20's) about 4.5 weeks ago.

- 2 to 3 weeks later noticed several lesions (groin and penis shaft) that were red, weeping a bit clear fluid

- Doctor visit at that point, full STD panel including herpes PCR. All test negative (3w 5d post incident)

- Same evening, noticed a small bump inside the skin on my penis shaft. Grew in size and pain over the next 4 days. Pain reached a pretty good point by then. Of course manipulating it a bunch (hard not to).

- On day 4-5 it drained a grey pus, dead skin on top cleared away leaving a crater, still infected but simply weeping clear liquid and a tiny bit of pus/blood.

- Second doctors visit on day 6, believe all incidents were some form folliculitis. At this point 3 GP's and a dermatologist have assessed me.

- Still hasn't healed yet (day 6) but that's to be expected I suppose for a deep cyst like that. The resulting sore is not hard, does not really have a raised border, and when free of spotted blood (if I clean it with sterile swab) is pinkish/skin colored. Now painless however.

Questions:

1. Do you believe this is a primary syphilis infection?
2. Incident to test was almost 4 weeks. Should I be comfortable enough there?

H. Hunter Handsfield, MD

74 months ago

Welcome to the forum. Thanks for your confidence in our services.

This isn't syphilis. It was a virtualy zero risk exposure in regard to syphilis (such parters rarely infected) and safe sex as well. Wrong lesion location. Lesions not suggestive of syphiils according to your description. Your doctors know what they are talking about: I agree with them.

1) Absolutely not syphilis. And just as atypical for herpes -- no worries there either. Folliculitis or other noh-STD skin infection sounds right.

2) The negative syhphilis test at 4 weeks is almost conclusve. For truly conclusive result, have another test at 6 weeks. It will be negative.

I'm confident none of this is any STD from the exposure described. Don't worry about it.

HHH, MD

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74 months ago

Thanks doctor, I will likely get another test this week to set mind at ease if nothing else. Update on it, the location itself is bit harder now after scabbing. I am assuming because of scar tissue and maybe slight inflammation. Basically I would describe it as a hard crater.

Questions on your reply:
1. For lesion location can you comment on that? My understanding is that the lesion can appear anywhere on the genitals.
2. Is there any statistics for 4 week testing?

H. Hunter Handsfield, MD

74 months ago

1) Probably I over-emphasized lesion location in my initial reply. For syphilis or herpes to take hold, the virus must be massaged into the tissues, and from your exposure, that could include the shaft of your penis. And 2-3 weeks is fine for onset time of syphilis, although longer than usual for herpes. But pllease note that I gave other reasons why this isn't syphilis or herpes. And neither herpes nor syphilis causes a pimple-like lesion from which pus or othe liquid can be squeezed out.

2) The syphilis blood tests probably pick up 90-95% of infections within 1-2 weeks of onset of syphilis lesiosn adn by 4 weeks since exposure,, so your negative test result also argues against syphilis. Have another syphilis blood test at 6+ weeks to help convince yourself on that score. As for herpes, you could also have a blood test, but that takes longer for conclusive results. Or see a doctor againt if sore(s) reappear.

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