[Question #7686] Potentially a chancre?

53 months ago

Hello there. Thanks again for all that you do.

On January 7 I received an erotic Thai massage from a CSW. Nuru gel and body sliding involved. There was minimal frottage lasting only a few moments and I don’t even recall that our genitals were directly touching for very long, if at all. This was followed by brief oral from her with a condom on, no intercourse.

6 weeks later (Feb 18) I notice a single red rash like, oval shaped spot on the shaft of my penis. Its about 3/8” in diameter. It’s not raised, it’s not firm, and in the 12 days since I noticed it it hasn’t really changed. It’s never broken into an open sore, and there has been no discharge or ooze. It has been slightly crusty and flaky. It looks kind of like a patch of psoriasis, at least that was my first thought since I have lived with a chronic low level of psoriasis or dandruff off and on my whole life (I am 46 years old) mostly on my knees, never on my genitals.

It is a tiny bit itchy and feels chafed and a bit raw. I have tried using a little Desonide (0.05) mild corticosteroid to see if it would clear but I’m thinking twice about that since I’m not sure and don’t wish to aggravate it.

But then I start reading about primary syphilis infections and now my anxiety is ramped up. Also have read that syphilis cases in the US are on the rise.

Is it possible this could be a chancre? It doesn’t seem to be behaving like one based on what I’ve read here but just thought I would throw it out to this forum for your opinion. Thank so much.

Edward W. Hook M.D.

53 months ago

Welcome back to the Forum. I’ll be glad to comment. The events you describe are exceedingly unlikely to result in acquisition of an STI however there is an exceedingly small chance that this could be a chancre. Syphilis is acquired through direct contact with an infectious lesion and there is a slight chance that during your encounter you contacted a lesion present on your partner. If the lesion is a chancre, at this time a RPR or other Syphilis test will be positive. Hence, given you acknowledged tendency to be anxious, I would encourage you to seek testing.

To be honest however, my suspicion is that the lesion you describe is a manifestation of your psoriasis. The description is typical and genital psoriasis is surprisingly common. If your Syphilis blood test is negative, contact your personal health care provider regarding treatment of what is likely a psoriasis flare.

Hope this helps.EWH

---

53 months ago

Thanks for the quick response. Follow up questions- how accurate is the RPR re: false possibilities tests?

I also received the COVID vaccination (Pfizer- 2nd dose) a week ago. Any chance this could throw off the RPR test?

Thanks again.

Edward W. Hook M.D.

53 months ago

There are no data to suggest that the COVID-19 vaccination causes false positive results in the RPR. Further, should the RPR be positive, there is a well-defined algorithm for further testing using other, unrelated tests to determine whether an initial positive test is detecting infection or is falsely positive. Concerns about false positive results should not worry you or keep you from testing. EWH ---