[Question #74] Syphilis Scare

39 months ago
Three weeks and 4 days ago I had cunnilingus with a Chinese csw unprotected. Last weds I noticed a sore that was painless on the back side of my Iip ( I sometimes but that area) the sore was round and white in the middle. it was slightly higher than the rest of the area but the edges were flat and not rolled. From that day forward it has been healing and changing appearance each day and looking better.   Since Thursday the middle has been flesh colored.If this was syphilis would it heal so quickly? I have only given superficial pecks to my wife and family...are they at risk if I have syphilis?

I have attached two pictures. One is the sore from last weds and the other from Friday...I tried to take one from today but is to small.  Does this look like syphilis?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your question.

The quick answer is that most likely this isn't syphilis. However, it's possible and you should be professionally examined ASAP, preferably before the lesion heals completely.

The details:

You don't say where you are, but heterosexually transmitted syphilis is rare in the most of the US, including in sex workers. And as you suggest yourself, the initial sore of syphilis (the chancre) usually doesn't clear up so quickly. And as you seem to know, it doesn't have an entirely typical appearance. Also, you don't describe a swollen lymph node nearby (e.g., under your jaw or ear, or the neck), which would be typical of most primary syphilis. OTOH, the exposure certainly could have resulted in syphilis if the sex worker has it; the timing, about 3 weeks after exposure, is perfect for syphilis; and a painless lesion also is typical.

Another issue is whether or not you have, or have had, similar lesions in or around the mouth. Although not typical for the chancre of primary syphilis, it looks very much like it could be a "mucous patch". These are a superficial sores of mucous membranes, like the inside of the lips and mouth or the female genital tract and are a sign of secondary syphilis, typically appearing 2-6 months after the initial infection. If have had other extramarital exposures in that time frame, conceivably you have had syphilis for a while. (I assume you don't have any sort of skin rash -- but let me know if you do.)

All things considered, based on the information provided so far, it is unlikely you have syphilis. But not so unlikely that you can safely ignore it. See a doctor about it ASAP. First try your local health department STD clinic, especially if you're in a major metropolitan area. These days health departments are just about the only medical services provide on-the-spot diagnostic tests, and often have the only providers highly familiar with the disease. And in the chance you have syphilis of any stage, the health department will need to be involved eventually, to help identify, locate, and evaluate and treat your commercial partner, and other partners possibly at risk.

As for as your own family, don't do anything yet. Most likely you don't have syphilis; and if you do, "superficial peck" kissing carries little or no risk. But with an oral lesion (perhaps especially if it turns out you have secondary syphilis with a mucous patch), I can't say the risk would be zero. But cross that bridge if and when you come to it. There's no need to 'fess up unless and the diagnosis is confirmed. They will be at no increased risk from waiting.

Please fill in any additional information implied above or let me know if you have any questions. Also please plan on returning with follow-up comments to let me know the outcome after you have been professionally evaluated. (I'm not going to hold you to the forum's usual policy of only 2 follow-up comments or questions.) In the meantime, don't panic. This is conservative, play-it-safe advice, and I genuinely expect it won't turn out to be syphilis.

Best wishes--  HHH, MD
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39 months ago
I have had a couple of different exposures in the time frame, all have been protected, oral and vaginal sex. I have been hyper sensitive and have made sure to look out for any abnormalities. I have had none. As for the sore being a mucus patch, it only had that appearance for about a day and then became pink again. I did bite my lip in that area a day before, but the appearance was a bit different then a sore from biting my lip (maybe I just got more of it) If this was a primary chancre would a test be positive now? If this was secondary syphilis would the mucous patch persist for such a short amount of time and be singular? I have had no rash... In viewing the picture does it look like a primary chancre?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
There's not much more to say. Mucous patches can come and go very quickly, so the quick healing doesn't argue strongly against it. I already said your lesion doesn't really look like a chancre -- but I also gave reasons why it isin't possible to be certain. Without question you need professional evaluation in person. Don't look for reasons to safely avoid it. There aren't any. Good luck and let me know the outcome.---
39 months ago
If this was a primary chancre would an rpr be positive at this point ( it is almost completely healed)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
If primary chancre, there's around a 50% chance of positive RPR; a negative result will not be reliable until 6 weeks.

My offer to keep the thread open for multiple follow-up questions is not unlimited. I'll have no further comments or advice until you report the results of professional evaluation in person.
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39 months ago
I appreciate keeping the thread open, I am not trying to yak advantage. The truth is there is nothing to evaluate, the sore is no longer there as of waking up this morning and there is nothing on my genitals. You stated that taking an rpr would not be fruitful at this point. What should my next move be. I will gladly follow your instructions and report back.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
OK. If you are confident it is gone entirely and that you have no other abnormal patches in your mouth, and no skin rash, you can safely hold off until 6 weeks after the event and have a blood test at that time. I would still recommend you do it in person with a professional experienced in syphilis. I'll leave the thread open until then, but won't have any more comments or advice until you post the outcome. In the meantime, to avoid potential confusion I would suggest you have no additional extramarital events until after the 6 week test.---
39 months ago
Forgive me, if you want to close the thread after this then I will gladly pay for another. I read on some old forum questions that a rpr will be positive a week after onset of chancre.  So if this was primary syphilis could I test Weds (that would be a week after onset? )Again I don't mind paying again after this answer. I really do appreciate your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
There is no precise research on time to RPR conversion, but 1 week after chancre onset definitely is not a reliable or generally accepted standard by STD experts. Six weeks is. You don't need to start another thread. This is already your second in a week or so. Just wait another 2-3 weeks, have the RPR, and post that result.---
38 months ago
Dear Doctor,

So I didnt really follow your directions, I became really nervous and after reading about five posts by Dr. Hook on medhelp that a positive rpr never lags more than 5 days behind the appearance of the chancre and that testing after that will provide an accurate result. 9 days after the appearance of the chancre (at that point the chancre was completely gone) I tested negative with a rpr. It was just over a month from the encounter.  I was happy with the result untill yesteday i noticed a pink spot on my trunk with what looked like a white head (which of course i picked off in my nervous state).  I have included a picture of it.  I'm assuming this is not a typical presentation of a syphilis rash and that it would be more wide spread. Are my results valid or should I test again....Thanks in advance for your response.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago

From the FAQs:  "Many times people want to send pictures of rashes or other issues. The experts are not allowed, however, to respond in any way to a photo or link to a photo. If you have questions feel free to contact ASHA at ashacustomerservices@ashasexualhealth.org." The photo will be deleted -- or perhaps the entire follow-up comment if the photo is embedded and cannot otherwise be deleted. Sorry.


Your test results are valid regardless of whatever sort of rash or other symptoms you have. You don't have syphilis. If your skin problem continues and you remain concerned, see a doctor about it.


That winds up this thread. Best wishes and stay safe.

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