[Question #7499] Syphilis on finger?

2 months ago
Dear Dr. Hook or Handsfield, 

I visited a Thai massage worker 31 days ago. She gave me a massage and a handjob only. I fingered her vagina for some minutes, primarily from the outside. Yesterday I noticed a very small skin growth exactly in the middle of the bent side of my index finger. It is really small (2 mm diameter), transparent/skin color and closed (i.e. NOT ulcerated). There is definitely no liquid coming from it. It seems "on the skin" and not "in the skin", doesn't seem to grow or change at all and probably is a wart which wouldn't have bothered me without the incident. 8 weeks ago I have been tested for HIV, syphilis, HCV, gon., chlam., all negative (and 2 weeks ago negative for Corona). 

My questions: 

1) From the description it does not at all fit with syphilis, right? 

2) The primary syphilitic chancre always ulcerates, i.e. finally breaks open, right? 

I guess my worries are totally unrealistic and hope that your professional opinion will  bring them to rest. I will celebrate Christmas with only my daughter and wife in these days and really hope to do so without worries. 

Respected Dr., I wish you a merry Christmas and good health, confidence and happiness in 2021!
Kind regards  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
 Welcome back, but sorry (again) you found it necessary. My reply is succinct, for the reason you understand from our previous discussions.

STDs are not transmitted by fingering, or so rarely that the risk can be ignored.

1) No, this doesn't sound like syphilis. Your description indeed suggests a common wart (unrelated to the massage events).

2) Yes, chancres always ulcerate.

Happy holidays to you as well. Stay safe.

HHH, MD

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2 months ago
Dear Dr. Handsfield,

thank you! Please allow definitely just one! follow up. 

You convinced me that the lesion  on my finger doesn't look like syphilis.

Today I realized a rash on my back and probably those are the same red spots I just always have.

But my triggered mind made me think if this possibly could be a syphilis symptom. Again, this "exposure" is now 32 days ago. So my only question:

1) How long does it roughly take from infection to the onset of the rash within secondary syphilis?

From what I know the timing is totally wrong for my rash to be possibly secondary syphilis. I hope if you confirm that I can let go. There is no other possible exposure than the one I mentioned. Before I have tested clean for everything.

In 2021 I will continue to work on the underlying issue. I have been doing good for quite long but obviously haven't completely won the battle.

I wish you a very merry Christmas, Dr. Handsfield!  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
1) How long does it roughly take from infection to the onset of the rash within secondary syphilis?  You answer yourself in the next sentence. You correctly understand. Two months minimum, usually 3-6 months.

Thanks for hte kind wishes. Fröhliche Weihnachten yourself.
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1 months ago
Dear Dr. Handsfield, 

I am well aware that my main problem is guilt. Still your answers together with my counseling efforts always helped to ease my mind (thanks!!!). I now had a syphils test done at 44 days after the "exposure". It came back negative. After a day of relief I found a new small bump, more like a hard blister, again 2 mm diameter at my palm. It could well be dyshidrotic eczema which I`ve already had at the sides of my fingers. I started to worry again... I recalled the event and remembered that besides the fingering she licked both of my palms and finally gave me a quick kiss (more a peck) right on the crack of my butt cheeks. Today is day 47 after the exposure. I have read that syphilis testing can take up to 90 days (huh!) to become totally conclusive. My questions:

1.) How reliable (percentages always help me) is a syphilis test (CLIA) at 44 days. Is it over 99%?
2.) Can you elaborate on the literature quote about 90 days? (It is common!) Is it just out of date, overly conservative and/or not compliant with modern tests like my CLIA?  
3.) I guess you will strongly recommend against repeating the test in again 6 weeks. Given my low-to-non risk exposure AND testing negative after more than 6 weeks the odds I could have syphilis now must be somewhere around 1: several millions. Do you agree?

I hope I am not annoying you with my questions. I have told you about my professional background and I am indeed leading my organisation through the lockdown-situation with distant-work and home office and endless negotiations with stakeholders and governmental organizations quite successful. I just want to quickly and effectively shake off my worries. Your confirmation and sound advice together with my counseling sessions always help(ed) me to do so. 

Thank you ever so much!

Best wishes, 
happy new year!
Karl  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
1,2) The syphilis blood tests are 100% conclusive (or very close to it) by 6 weeks. Three months is just an even more conservative interval, which among other things covers persons who may be partially treated because they took an antibiotic. For example, extending to 90 days would make sense in someone treated for gonorrhea with a regimen such as single dose ceftriaxone, which would cure gonorrhea but perhaps temporarily suppress syphilis without curing it. This is a common scenario for much syphilis testing.

3) I would put the chance you caught syphilis from the event describe as zero.

Take care and stay safe.
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