[Question #7599] HIV and Syphillis testing

2 months ago
Hello, I am back after recent symptoms, and would like to see if Dr. Handsfield can answer this question since I talked to him the first time about a similar experience. Please I would appreciate it much. I visited a strip club 9 days ago, I had a few VERY rough lapdances, and I also had protected oral sex that lasted no more than 4-5 minutes, condom was on from start to finish, and I am 99% sure the condom did not rip since I checked in the restroom straight away after I was finished. The rough lapdances caused multiple friction burns, as I inspected my penis right after the oral as well it also left my penis really red, irritated and inflamed, even had an open scar on my penile glans/head of penis that I discovered the next day after such events. Long story short the inflamation continued days after, and the scars/sores are healing slowly but they are healing.

What I am back here for is because 2 days ago after checking my penis out after it was stinging more than usual. I discovered multiple open sores that were oozing from different parts of my foreskin area where the inflamation was at in the first place. They also produce a white gooey liquid that forms on my foreskin, not from inside my urethra, after I leave my penis alone for a while, and go back to the restroom after a bit, same as last time with the tea tree oil incident. This started to form 7 days after the strip club incident, and were not there before. The timing has me worried, on to my questions.

1. Do you believe it is part of the healing process to the inflamation caused by friction burns, what could the white gooey substance be ? Is it skin trying to form ? It looks very very similar to when I applied tea tree oil, that caused my skin to burn last year.

2. Do you believe since I developed new lesions/symptoms I should go ahead and test for stds, I do have hsv1 , am I at a higher risk, especially since I had cuts and inflamation from the past lap dances that same day ? (oral occured at the very end of the day) although I am sure the condom covered where the open sores/lesions are at now.

3. If this was syphillis sores , if I test for it now or sometime this week would it show as a positive for syphillis ?

4. Should I test for other stds, that can cause similar symptoms to the one I mentioned ?

5.Is it possible continue unprotected sex with wife after my sores heal down there , without putting her at risk ?

6. Should I still test for HIV at 6 weeks, or do you not see it neccesary ? I am paranoid, and always have what ifs in my head such as, what if the condom ripped and I didnt notice , or what if in the process of the lap dance I penetrated her without even noticing. It sounds crazy  I know, but you should know as an experienced doctor how the minds of worried people work. Mind you that this is the same stripper from last time and is very careful with these sort of things, uses hand sanitizer before and after, and seems to use condoms the right way. I dont understand why I fell in the same trap knowing its not right, and that I do not deal with these situations correctly.

Thanks again for your help doctor.



2 months ago
I wanted to add that the white gooey liquid is not smegma, which I made it sound out to be, it forms where the open sores/lesions are at. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Welcome back to the Forum.  I will be answering your question as it was assigned to me.  Further as it is a follow up to the questions you asked last week, it seems appropriate for me to continue to address your concerns.  FYI, Dr. Handsfield and I have worked together for nearly 40 years and never differ in the substance of our replies although or verbal styles vary.  My assessment of the encounter you describe is unchanged- this was a no risk event for acquisition of STIs, including HIV.  It. Sounds as though the abrasions you acquired from the lap dance may have become infected, most likely from the bacteria normally present on the skin, unless you have been treating them with something to help them heal.  Have you applied anything to the abrasions?  The inflammation and oozing you are experiencing may be part of your body’s reaction to the infected abrasions.  My advice is to see a doctor for him/her to assess the area and consider whether or not you need antibiotics.

In answer to your specific questions:
1.  See above.  Without seeing and examining you I cannot fully assess the gooey material but it sounds like an inflammatory response, either to some sort of infection of the sort I mentioned above or if you’ve been putting something on it, something in the treatment.

2.  Of course you are free to test if you wish.  Medically it is not essential.  Sometimes after trauma herpes infections reactivate but what you describe sounds worse than would be expected from that.  Nine days is a bit early for Syphilis lesions to appear.

3.  If this were Syphilis, since the lesions have been present for several days, a Syphilis blood test would be positive.

4.  See above.  

5.  Continued sex with your wife would not put her at risk but it could further irritate the sores.  Remember, sex is all about friction.  Parenthetically, if you’ve been having unprotected sex with your wife, this too could have led to infection of friction areas.

6.  The exposures you describe are no risk events for acquisition of HIV.  Feel free to test if you feel the need but I am confident that what you have described did not put you at risk for HIV.

Hope this helps.  Have someone take a look and see if you need antibiotics. EWH 
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2 months ago

Hello Dr,


Thanks for your quick and throughout response, As of now I only have a few questions left, I hope you can answer to the best of your ability, and after that I would like to keep this thread open. I know I have one more reply after that, just in case I have a question if  and when I decide to get tested. 


1. Ive had these lesions now for 2 days, how much longer should I wait so I can know if these were truly caused by syphilis ? I know the key rule is to wait 6 weeks to get reliable results, but I just want to rule these lesions out for now.


2. Are there any other stds out there that cause similar symptoms to the ones I mentioned ? Open sores that ooze, and to put it in better terms a white discharge from the lesion itself ? 


To answer your previous question, yes I am using creams I was prescribed last time when I had the same symptoms I am experiencing now.  I am using gentamicin, and nystatin. They seem to be having a positive effect. Do you believe I should go to a doctor to pick up antibiotics ? I was given cipro and azithromycin last time.

Its just scary to find these lesions where you least want them after receiving oral sex, it automatically makes you think its an std, you know ? Especially when there could be that slim chance saliva couldve gotten its way inside the condom and into the lesions. Is it the saliva that transmits stds when for example when someone has unprotected oral sex or how does it happen if you dont mind giving me more insight on that .







2 months ago
To add to the 1st question, dont know if I was clear or not, but after one shows penile lesions, for me its been 2 days, how long does it take after they first appear for a test to catch syphilis ?
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Thanks for your follow up and additional information.  We can certainly keep the thread open following this response.  Regarding the creams you are using, some of these do occasionally cause irritation which can cause ulceration.  The fact that you earlier received ciprofloxacin and azithromycin for your prior similar symptoms suggests that your health care provider was concerned about secondary infection of abrasions, just as I suggested earlier and reinforces my suggestion to have a clinician take a look. 

Regarding your follow-up questions:
1.  While standard recommendations suggest that it may take up to six weeks following exposure for blood tests to become positive in asymptomatic persons, more typically lesions occur about 3 weeks following exposure on average (thus yours have occurred a bit early).  Once lesions appear, blood tests become positive within 2-3 days of appearance.  Thus a negative blood test at this time would be strong evidence that your lesions are not due to Syphilis.

2.  The only other STI which might cause oozing lesions of the sort you describe is Chancroid, an STI which has never been common in the U.S. or Western Europe and now is rare even in sub-Saharan Africa.  Further are no data to suggest that persons have ever acquired Chancroid from oral sex.

Saliva does not transmit STIs, direct contact with infected sites of infection do.  In addition, there is simply no data to support your suggestion that saliva might slip into a condom during receipt of oral sex.

I hope these explanations help.  My initial assessment remains unchanged. EWH 
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2 months ago
Hi Doctor,

Thanks again for your response, I hope this one doesnt count against me, I just wanted to know real quick what cream it is that causes irritation which may cause ulceration, so I can talk about it with my doctor once I see them ? Also is Chancroid an STD I should worry or test for ? I have never heard of this specific STD, and if so are these included in those basic 10 panel STD tests ? 


Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
These follow on “clarifications” are taking advantage of my agreement to keep the thread open for a “final” question that you request.  Brief answers:

Components of any cream can be a source of allergy and inflammation.

Chancroid is too rare a problem to worry about.  I indicated that, indirectly above
EWH 
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2 months ago
Hello Dr,

I have now received all my results and tested negative for every STDs except HSV1 as expected. Although I know some of them were to early I feel a tad bit more releived. The cuts found the next day from the lap dance incident have completely healed, The irritation that became an open lesion from the left and right side of my foreskin have healed very good, id say about 70-80% healed from the left side, and 100% healed from the right side. My doctor found it appropriate to prescribe me 5 days of Valtrex as he suspected it was an Hsv flare up, although I told him my swab came out negative when I did test it for Hsv. I believe the medication had a big part on my speedy healing. On to my questions.

1. From when I first saw the irritated lesions become ulcerated to when I took the STD tests 5 days passed. Is that enough time passed to make sure the test wouldve picked it up if it were per say Syphillis ?

2. Do you beleive I should test again at 6 weeks for STDs again?

3. Not sure if you could answer this for me or not since this website is meant for sexual health questions, but should I suspect penile cancer as a cause ? If it were penile cancer would it have healed in general or at least as quick as it has ?

4. I discovered this black dot towards the bottom end of my foreskin close to my shaft 2 years ago, could be since I was born honestly, but I am afraid of it not just being a birthmark. Id say theyre less than 2 mm in size. They have not changed appearance since I discovered them. Plus ive had 3 occasions of ulcers on my penis which is another symptom of penile cancer which happened in the last 2 years, 2 being in the last 4-5 months. Which the last 2 healed 100% completely. Should this be alarming ?

Again, thanks so much for your help. I hope not to have to come back here again. No offense, you guys do a great job for worry wells like me.

Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Thanks for the additional information.  There remains no evidence that this was an STI of any sort.  I’m glad the sores have healed.  Final responses before this thread is closed.

1.  As I said before, if this had been Syphilis your Syphilis blood test would have been positive.
2.  I see no reason for additional testing at 6 weeks.
3.  If this were penile. Anger, the sore would not have healed.
4.  Sigh.  There is no reason to suspect penile cancer.  The “black dot” does not raise alarms.  It only suggests that you are looking at your penis more closely than previously.

Thanks for your thanks.  Glad you found my comments helpful.  End of thread. EWH 
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