[Question #7403] Syphilis questions

3 months ago
Hi Doctors, I have a couple questions regarding syphilis risk as I am getting quite anxious.
*  I am a bi man, but have really sporadic encounters with men (and almost always get anxious after the fact). For this exposure 9 months ago: 
Mutual masturbation with genital to genital contact, he finished on my hand and chest. Hand had no open wounds, if anything some healing skin as I sometimes bite my nails, but probably healing for a couple days at that time.  Skin on chest intact, some on chin with beard coming out, but again, nothing opened.
 6 weeks later I (must admit) got anxious as I noticed a small hard bump on my penis shaft, and because of touching and scratching it a lot skin got sore and painful; I recalled having this bump forever but anxiety dominated me. Went to urologist and was said it was a small cyst (note that it is still today), ruled out chancre when explicitly asked about it. What worried me was that 8 weeks later (14 after encounter) I developed a rash (similar to chicken pox) but ONLY on my upper back and shoulders, not itchy, and nothing on palms and soles, it also never expanded at all, and the very next day it started going away while putting hydrocortisone cream. No traces of it after 3 days. 2 general physicians said it looked like allergic dermatitis, as I had ZERO other symptoms, no fever, pain, etc... Does this sound like syphilis to you.

* Second, yesterday: Encounter with a gay man, stranger. Discussed STI status thoroughly and he said he was all neg, on PREP and tested 3 weeks ago for everything else. Encounter was around 10 secs of genital rubbing, he licked my testicles (no penis), rimmed me and fingered me for a few minutes, and that  was all. Am I at any risk for Syphilis? What about any other STIs?

I think guilt is consuming me here, as I had been dating a wonderful woman for a while and I guess that is playing me games. Given the experiences there, would you say I can keep on having intimacy with her safely?
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Welcome to the Forum. Thanks for your question.  I'll be glad to provide some information.

Among STIs syphilis is relatively rare.  At the same time it is an infection whose manifestations are highly variable and unlike most more common STIs, can theoretically be transmitted through non-penetrative sexual contact.  Each of the encounters you describe sound to be very, very low risk.  A few more specific comments:

Encounter 1.  The lesion you noted does certainly sound like a cyst.  A syphilis lesion would have gone away within a few weeks of its appearance.  As for the rash you describe, hydrocortisone cream would make the rash of syphilis worse, not make it go away.  Neither of these things sound like syphilis. 

Encounter 2.  These activities are all likewise extraordinarily low risk for syphilis or for that matter other STIs.  STIs are not spread by licking including in the course of rimming or fingering.  This partner's history of testing is likewise quite reassuring.

Bottom line- these are very low risk encounters with close to no risk for syphilis or other STIs.  I would not be worried about unprotected sexual contact with your regular female partner.

 I note however that you do not mention getting tested for syphilis.  If you have not, I would encourage you to do so as a negative test will provide you with further assurance that you did not acquire syphilis.  At any time more than 30 days after an exposure, a negative blood test for syphilis will rule out any likelihood of syphilis. They are cheap and can typically be obtained confidentially.  EWH

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3 months ago
Thank you so much!

Indeed, hard bump is still there, and as I said, I think it has been for ages. I was guessing me using hydrocortisone could "hide" the typical full body, hands and feet characteristic rash. It is good to hear it would in fact have made it worse. 
One thing I forgot to mention is that, around 3 weeks after the first encounter I was put on 7 days amoxicillin due to an unrelated sore throat . I know amoxicillin is not indicated for syphilis, but would that have also helped in case there was a real exposure?
No, I did not test for syphilis, as urologist was really clear on me not having to worry about it and only gave me some cream to restore the damaged skin I self provoked.
Then for rash, 2 doctors fully ruled out any viral or bacterial cause, I came back home after a couple years and used a "clean" shirt (had been stored there all the time) so I attributed it to a dermic reaction.
On second encounter, I also did not see any obvious sores on the mouth (but of course did not look at tongue).

It seems to me your recommendation on getting tested is for me to be at peace, and for general good sexual health practices; but not because you think there is a medical reason to do so, am I right?
If that is the case, were I not to get any symptoms over the next few weeks, can I safely move on? I guess the only risk is related to HPV and Syphilis (maybe gono) but those two would be quite obvious I suppose.

I will leave my other follow up to comment after a couple weeks whether something changes or not. 
Edward W. Hook M.D.
Edward W. Hook M.D.
3 months ago

Actually, a week of amoxycillin, while not recommended therapy, would probably have cured syphilis that had not yet become obvious. 

You are correct regarding my suggestion to test.  You have acknowledged you are nervous.  The peace of mind a negative test will provide is a worth it.  If you have some other reason for not testing, then yes, the absence of symptoms over the next few weeks would strongly suggest that you were not infected.  EWH

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