[Question #7339] Is this a chancre?

4 months ago
Hi,

I noticed a red bump on the shaft last Friday (close to scrotum) and I am worried on whether it is a syphilis sore.

I went to the clinic and waiting for a full STD results. I was prescribed with doxymycin (100g) and azithromycin (500g) for a 5 days course with an antibacterial cream.

I read from articles and understand that a bump can ulcerate to become chancre within a week. I am just wondering how does a chancre look like? 

I did pinch the bump and some clear fluid with blood came out. How can I upload a picture for the experts to see whether the bump I am having is a chancre?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome to the forum. Thanks for your confidence in our services.

Unless there's an incredible coincidence, you're the same person who posted a similar question on HealthTap, another health advice website. Here is part of my reply on HealthTap:  "Chancres are open sores, not skin bumps. However, if it's been under a week or so, maybe the bump will begin to ulcerate, becoming a chancre." However, you and your doctors have done exactly the wrong things:  you now may never know if you had syphilis or not. I is not usual or recommended practice to treat something like this before confirming the diagnosis. What did the examiner say about syphilis? Was testing done, e.g. darkfield microscopy or a syphilis blood test? If it's syphilis, doxycycline for only 5 days, plus azithromycin, is insufficient to cure syphilis -- but is sufficient to make future testing unreliable. (Did your doctors really suspect syphilis? Or did they think there was another reason for treatment?)

We do not accept or comment on clinical photos on this forum; that comes too close to practicing medicine from a distance, which we canot do. My only advice at this time is to continue working with your doctors about next steps. Good luck.

HHH, MD
---
4 months ago
Yes, I am the same person in Healthtap.

The examiner says it does not resemble syphilis and he suspected some skin infection.

Before the 5 days course, which was last Saturday, a blood test for Syphilis was done, but results are not back yet.

I had finished the 5 days course and in that case, when should I retest again to get conclusive results?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Thanks for the additional information.

If your current syphilis blood test is negative, it will confirm this problem wasn't syphilis, and no further testing is needed. Your current result will be conclusive.
---
4 months ago
Thanks dr for the prompt reply. This will be my last question.

I read articles stating that Syphilis blood test can only detect the antibodies a week after the chancre appears, or 6 weeks to be conclusive.

In my case, as the blood test was done last Saturday (about 4 weeks and 1 day), it will still be conclusive?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
The syphilis blood test is reliably positive once a chancre has been present 7-10 days. In absence of symptoms, 6 weeks is considered standard. The other aspect is that the risk of syphilis from such an exposure is low. Even if the blood test isn't quite conclusive, that result combined with the low overall risks amounts to near certainty you don't have syphilis. However, the other wrinkle in this situation is  your treatment with doxycycline and azithromycin -- in doses that could transiently suppress but not cure syphilis. All things considered, I think the chance you have syphilis is so remote that no additoinal testing is needed. However, if you feel you need absolute 100% confirmation, I would recommend a final blood test 3 months after the exposure. (You could also get one at 6 weeks, but because of the antibiotics, I wouldn't consider it quite conclusive.)

In the meantime, stay mellow. It is very unlikely you have (or have had) syphilis.

This being my third response, it concludes this thread. I hope the discussion has been helpful. Best wishes and try not to worry!
---
4 months ago
Thanks dr for the informative reply.

Just to update, my test results came back (4 weeks after exposure and one day after appearance of the bump). 

RPR - non reactive
TPPA - non reactive
Other STDs - non reactive except for HSV1 which I had it orally since a long time ago

I guess I can stop worrying as it indicates the sore is not due to syphilis. I will retest again on the 12 weeks as recommended.

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
It still is conceivable -- but unlikely -- that without the antibiotics, the bump would have progressed to an open sore, i.e. a chancre. If your 12 week test result remains negative, you'll know for sure you do not have syphilis. However, it will not tell (and you will never know for certain) whether you never had syphilis or had an early case that was successfully aborted by doxycycline and azithromycin.

I intended to close this thread after the last comment -- but am doing so now. I hope the discussion has been helpful.
---