[Question #6456] Syphilis Symptom

67 months ago

I will try to make this as simple as possible.

Exposures:06/12 - condom csw vaginal and unprotected oral10/12 - unprotected csw oral sex received 19/12 - condom csw vaginal and unprotected oral (dont think it is relevant given the timeframe for this situation)

Symptoms:25/12 or 26/12 - what looked like a ingrown hair appeared on the shaft of my penis (I would say half way between the head and scrotum).

I have some hair next to it so assumed it was the same. It was small and white so popped it and pus came out. Very next day became what looked like slightly infected and I popped it again and some pus came out again but not much. I then decided to leave it alone as it was getting slight worse and bigger. It was raised and circular, quite red probably irritated. During these 2 days it was tender to touch (touch only). It started getting better and went down but stayed as a circular the size of my pinky nail. It is going down slowly I think but hasn't ulcerated in my opinion.

Doesn't seem open and feels like soft skin, perhaps scaring skin. I'm trying to be rational and believe that the exposures were very low risk for such infection and very unlikely from what I've read but as this showed up it has been difficult. I posted here a couple of weeks ago because of a groin/muscle pain on my left leg and Dr Hook said it was probably a mechanical issue and turned out to be true as it went away after some exercise and stretching (also saw a GP and he confirmed the same).

I'm now a bit concerned because I continued unprotected sex (as suggested by Dr Hook), with my gf, last time on the 25th when maybe the lesion was still what looked like an ingrown hair. I cant visit now a dermatologist as I'm travelling with my gf and will only be able to do in 10 days or so.

Edward W. Hook M.D.

67 months ago

Welcome back to the Forum. I'll try to comment. As I mentioned in our earlier exchange, most CSWs do not have STIs and amongst the STIs syphilis is particularly uncommon. further, only your receipt of oral sex was unprotected and syphilis is almost never spread by oral sex. The lesions you describe are very typical for folliculitis and not at all typical for syphilis. In some cases of folliculitis a hair is seen nearby the lesion which typically resembles a pimple. Syphilis lesions do not have pus that can be squeezed out while folliculitis lesions do. In addition, typically when folliculitis lesions are squeezed they can be tender afterwards in the manner you describe.

For all of these reasons, I find it very unlikely that you have syphilis. I would not worry. If you wish you could get a syphilis blood test which, more than 3-4 days after your lesion appeared would be positive although I really do not feel that this is necessary.

I hope these comments are helpful. What you have sounds like typical folliculitis, not syphilis. EWH

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67 months ago

Hi Dr,

Thank you so much for your fast reply, especially on NYE which made me feel way more relaxed and probably will able me to enjoy the NYE celebration without so many anxious thoughts.

I wonder how long is normal for this type of lesion to last then, being folliculitis?

I did read a Dr HHH reply where he did mention that syphilis lesions wouldn't have pus to be squeezed and thats why I believed it is not syphilis.

Given all of this and what you said I'm more inclined to just put this behind me and stick to my normal life without even testing as you suggest. This will include obviously continue unprotected sex with my regular partner.

The only thing that really scares me is the timing of the lesion to appear, the size and how long it is taking to heal (has been 6 days now).

Once again thank you and I wish you and the team a happy new year.

67 months ago

Also let me add that what concerns me is that even if the typical description of syphilis lesion seems to be an open sore, ulcer, it also says that can vary and could be what my lesion is? That's why I found a need of posting here. Thank you.

Edward W. Hook M.D.

67 months ago

The variability in syphilis lesions occurs at the later (secondary) stages of syphilis, not with the initial lesion. I have never heard of an initial lesion of syphilis which was pustular.

The best way to manage folliculitis lesions is to keep them clean, washing gently with soap, water and perhaps a wash cloth. Lesions that have been squeezed may take longer to resolve but as long as it is not getting larger, there should be no reason for concern. Please do not squeeze it further. EWH

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67 months ago

Hi again Dr and thank you for your reply.

I waited a little bit longer to see of there were any develop.ebt on the lesion.

It seems to me that has decreasing in size and redness, but it is still a bit red around it. It seems like I see a white dot on the center of it but I have not and will not try to pop or squeeze it.

According to all you said I'm assuming that then it is safe to not worry, no need to test and keep moving on with my normal life?

I assume this by the exposure and all the reasons you have given. If that's it please confirm and I will accept your suggestion and move on.

Thank you once again. Wish you all the best. HNY

67 months ago

Let me just please add that all together even if it still takes one more week to heal? As it seems to be healing very slowly? Would it be normal? Thank you

Edward W. Hook M.D.

67 months ago

Rates if healing of such lesions after they have been squeezed vary and I am not surprised that while there has been improvement, there may be a bit of residual redness. My assessment has not changed. It is clear from your posts that you are concerned nonetheless. The best way to resolve your concerns is to get a syphilis blood test. I anticipate the result will be negative and when it is, you can move on with no concerns whatsoever.

Note- I recommend the blood test for the purpose of providing you with reassurance, not because I am concerned that the lesion you described is due to syphilis.

This will now complete this thread which will be closed without further responses. Take care. EWH

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