[Question #8168] Syphilis? Something Else?
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48 months ago
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Hi Doctors. Thx for all of the help in your forums. I will try and keep it brief.
On Day 0, I was very intoxicated and had 31 yr old woman perform oral sex on me. It could have included vaginal sex as well, but I don't think so. I was too drunk to remember.
Day 0 - described sexual event
Day 3 - took 1g Azithromycin as a precaution against gonorrhea, chlamydia.
Day 5 - began experiencing mild symptoms, urethral discomfort, itchiness in head of penis, etc
Day 7 - Full STD Panel test, negative for everything (chlamydia, gonorrhea, syphilis, herpes, everything)
Day 14 - itchy/discomfort feeling in penis persisted on the head of penis
Today is Day 19, and today I discovered a bump the size of the head of an ink pen on the underside of the head of my penis. I would not say that it hurts but generally is uncomfortable. It appears to be the source of the discomfort.
My questions for you:
1. I understand the syphilis is rare in straight men, but could this be the beginning of a chancre of syphilis?
On Day 0, I was very intoxicated and had 31 yr old woman perform oral sex on me. It could have included vaginal sex as well, but I don't think so. I was too drunk to remember.
Day 0 - described sexual event
Day 3 - took 1g Azithromycin as a precaution against gonorrhea, chlamydia.
Day 5 - began experiencing mild symptoms, urethral discomfort, itchiness in head of penis, etc
Day 7 - Full STD Panel test, negative for everything (chlamydia, gonorrhea, syphilis, herpes, everything)
Day 14 - itchy/discomfort feeling in penis persisted on the head of penis
Today is Day 19, and today I discovered a bump the size of the head of an ink pen on the underside of the head of my penis. I would not say that it hurts but generally is uncomfortable. It appears to be the source of the discomfort.
My questions for you:
1. I understand the syphilis is rare in straight men, but could this be the beginning of a chancre of syphilis?
2. Would the 1g Azithromycin I took prevent syphilis from ever infecting me?
3. Could this be the beginning of herpes? HSV1 or HSV2? It is only one isolated and uncomfortable dot. What else could this be? It almost looks like a small pimple.
4. When/how will I be able to finally say that I am free of STDs? I want to put this behind me more than anything.
5. When would you recommend someone get tested for HSV?
6. What would you recommend I do from here?
Thank you for your help again
4. When/how will I be able to finally say that I am free of STDs? I want to put this behind me more than anything.
5. When would you recommend someone get tested for HSV?
6. What would you recommend I do from here?
Thank you for your help again
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H. Hunter Handsfield, MD
48 months ago
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Welcome to the forum. Thanks for your confidence in our services.
All things considered, it is very unlikely your current persisting symptoms are due to syphilis, and some of your questions indicate you understand some of the reasons. In the US and other industrialized countries, the frequency of syphilis is sexually active women (including sex workers) is very low, and among infected persons, oral infection is less transmissible than genital or rectal -- so probably you were not exposed. That doesn't mean zero risk, but definitely low risk. If vaginal sex occurred, the risk probably would have been higher, but still on the low side. And most of your symptoms, other than the current penile bump, are not consistent with syphilis -- both the nature of the symptoms and their timing are wrong (too early). To your specific questions:
1. Early chancre? Probably not but conceivably yes. Chancres start as intact bumps that soon ulcerate. If it doesn't change to an open sore in a couple of days, that will further argue against syphilis. If it does ulcerate, maybe. VERY IMPORTANT: HANDS OFF! No prodding, squeezing, or other manipulation of any kind. Those things could cause ulceration themselves and impair later diagnosis.
2. Some syphilis strains are resistant to azithromycin -- 20-50% depending on where you are. Azithro would prevent syphilis if exposed to a susceptible strain.
3. This doesn't sound like herpes, but it may be possible.
4-6. You should stop all efforts at self evaluation and diagnosis and see an STD-knowledgeable health care provider ASAP. You need in person care to properly evaluate the situation and direct testing and clinical evaluation. That may or may not include HSV testing, dark field examination for syphilis (not available as a self-collected test at any laboratory), and general evaluation with physical exam etc. Your local health department STD or sexual health clinic would be ideal -- but STD knowledge often is poor at walk-in clinics and emergency departments.
Let me know if anything isn't clear. I'd love to hear the outcome after you have been professionally evaluated. I hope these comments are helpful in the meantime.
HHH, MD
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48 months ago
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Hi Dr-
Thank you for the great reply.
It has officially been a week since I posted my question here. The penile bump/pimple has not changed in size, and has not opened or ulcerated. It has stayed the same and kept the same symptoms as originally described...somewhat painful/irritated. It only feels like a pimple under the head of my penis. So, my follow up questions are:
1. Because this has not ulcerated at all, should I still go be evaluated? Should I even be worried about a potential infection at this point, or chalk up this scare to anxiety? This Thursday 9/2 will be 4 weeks since the exposure, with this being my only "symptom."
2. If I am to be evaluated/tested...is 4 weeks enough time to get conclusive results? If this is a chancre, would the results of the test have to be positive due to my body responding to the infection?
Thank you for the great reply.
It has officially been a week since I posted my question here. The penile bump/pimple has not changed in size, and has not opened or ulcerated. It has stayed the same and kept the same symptoms as originally described...somewhat painful/irritated. It only feels like a pimple under the head of my penis. So, my follow up questions are:
1. Because this has not ulcerated at all, should I still go be evaluated? Should I even be worried about a potential infection at this point, or chalk up this scare to anxiety? This Thursday 9/2 will be 4 weeks since the exposure, with this being my only "symptom."
2. If I am to be evaluated/tested...is 4 weeks enough time to get conclusive results? If this is a chancre, would the results of the test have to be positive due to my body responding to the infection?
3. Assuming the female DID have syphilis...I think the highest possible odds of me getting the infection would be the following: (If exposed, 33% chance of passing it on, and if passed on to me, 50% chance that the 1g Azithromycin did not kill off the infection) .33 x .50 = highest potential infection rate is 16.5% ????
4. My fear at this point would be getting tested at 4 weeks only to have the test miss a positive result that it would have picked up at 6 weeks. Should I do it now? Wait? Or stop worrying in general? I would love to take a test at 4 weeks just to put my mind at ease.
5. As far as herpes go...I have not developed any symptoms beyond what is discussed here. Should I be tested/evaluated here as well? When would symptoms of HSV show up, and when would a test for HSV become conclusive? Would my testing at 4 weeks along with syphilis be conclusive here too?
Thank you !!!!!!
5. As far as herpes go...I have not developed any symptoms beyond what is discussed here. Should I be tested/evaluated here as well? When would symptoms of HSV show up, and when would a test for HSV become conclusive? Would my testing at 4 weeks along with syphilis be conclusive here too?
Thank you !!!!!!
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H. Hunter Handsfield, MD
48 months ago
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1. Almost certainly this is not an early chancre or any other STI from the exposure you have described. Whether or not to seek medical attention is up to you: I see no important reason except your possible curiosity.
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2-4. Probably 80% of newly infected people would have a positive blood test at 4 weeks, so a negative result would be modestly reassuring, but conclusive at 6+ weeks or more after exposure. I don't accept the premise "assuming" your partner had syphilis; syphilis is currently uncommon in women in the US, including sex workers, and the chance she has it probably is less than 1 in a thousand. (Most syphilis in the US is in men who have sex with men.) But in the unlikely chance she had it, there are no data at all to judge the transmission risk, but I would guess under one chance in several hundred, probably less than 1 in a thousand. Since there's under one chance in a thousand she has syphilis in the first place, the chance you caught it is probably on the order of one in a million, tops. If azithro cut that risk in half, it's one in two million. Please get it in your mind that that means zero risk for all practical purposes. Personally, if I were in your situation, I probably would not be tested at all -- or if curious, would have only a single test at 6 weeks.
5. Nobody should ever be evaluated for genital herpes after a single oral exposure, unless there are obvious symptoms to suggest a new HSV infection, which you do not have. The HSV blood tests are notoriously unreliable in this situation. I strongly recommend against an HSV blood test.
I have the feeling you're reacting emotionally to a sexual decision you regret. Don't confuse those feelings with infection risk: they aren't the same.
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47 months ago
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Hi Doctor
As my final question, I would really like some clarity on a few things, as I am afraid now that I may have herpes. While I really only have one bump still on the underside of the head of my penis (maybe two if you really look closely?????) I am concerned that this may be the cause of this bump.
1) I noticed this bump 19 days after exposure. While it very well could have existed before then, I have only noticed the slight irritation after my exposure. The bump has not grown in size, opened, generated puss, or really done anything. Just a skin bump that happens to be there and may have another slight one next to it if you look closely. Does this resemble herpes? What should I be looking for in evaluating herpes symptoms in my genitals?
2) Today is almost 6 weeks post-exposure. I have now noticed this bump existing for 3+ weeks. If this were herpes, when would this symptom go away?
3) In previous forum posts, Dr. Warren says that herpes symptoms is a series of water blisters. My bump does not have a head like a pimple as I have seen in pictures, and certainly does not have a "poppable" quality to it. Could my bump still be related?
4) I am a math professional so my brain must go to the odds/chances. What are the odds that my partner here had herpes/what are the chances I contracted the virus/what are the odds that I would still be experiencing a symptom on Day 40 after exposure?
5) Assuming I have herpes, what are the chances I ever pass it on to a permanent partner?
6) Would you recommend testing again for my 1/2 bumps? Is that normal for herpes? I know my anxiety is playing a role here but I want to put this to rest. Anything you could do to educate me on herpes, and what typical symptoms and timelines are, would be very helpful.
Thank you
As my final question, I would really like some clarity on a few things, as I am afraid now that I may have herpes. While I really only have one bump still on the underside of the head of my penis (maybe two if you really look closely?????) I am concerned that this may be the cause of this bump.
1) I noticed this bump 19 days after exposure. While it very well could have existed before then, I have only noticed the slight irritation after my exposure. The bump has not grown in size, opened, generated puss, or really done anything. Just a skin bump that happens to be there and may have another slight one next to it if you look closely. Does this resemble herpes? What should I be looking for in evaluating herpes symptoms in my genitals?
2) Today is almost 6 weeks post-exposure. I have now noticed this bump existing for 3+ weeks. If this were herpes, when would this symptom go away?
3) In previous forum posts, Dr. Warren says that herpes symptoms is a series of water blisters. My bump does not have a head like a pimple as I have seen in pictures, and certainly does not have a "poppable" quality to it. Could my bump still be related?
4) I am a math professional so my brain must go to the odds/chances. What are the odds that my partner here had herpes/what are the chances I contracted the virus/what are the odds that I would still be experiencing a symptom on Day 40 after exposure?
5) Assuming I have herpes, what are the chances I ever pass it on to a permanent partner?
6) Would you recommend testing again for my 1/2 bumps? Is that normal for herpes? I know my anxiety is playing a role here but I want to put this to rest. Anything you could do to educate me on herpes, and what typical symptoms and timelines are, would be very helpful.
Thank you
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H. Hunter Handsfield, MD
47 months ago
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1,2) The bump you describe is not possibly herpes. If it were, it would have become an overt blister, then an ulcer, than a scab, and by now it would be healing or enitrely gone. You didn't catch this during the sexual exposure described. It's just something that happened to appear when it did, or that you noticed for the first itime.
3) I agree with Terri's description.
4) Half of all adults have oral herpes, usually without symptoms, but transmissible outbreaks are uncommon -- there's probably under 1 chance in a thousand (this is only a guess) she had transmissible oral herpes at the time of your exposure. Even then, the odds of transmission are probably no higher than 10%. And catching HSV usually (more than half the time) would have caused typical symptoms, which you have not had. Finally, since half of all adults in the US have HSV1 (the only type teansmitted by oral exposure), that's the chance you already have it yourself -- in which case you are immune to a new HSV1 infection, anywhere on your body. I'll let you do the math on how these figures translate to the chance you acquired genital herpes, but it comes to a very low number.
5) Genital HSV1, unlike HSV2, has infrequent recurrent outbreaks, and most herpes experts have never had a patient who acquired genital HSV1 by vaginal sex: all cases acquired by oral sex. So even if you acquired genital HSV1, probably your partner(s) would not be at risk.
6) There is no useful test on a lesion like you describe. You should see an expert, preferably a dermatologist, who undoubtedly will be able to make an accurate diagnosis visually.
Do your best to separate your anxieties about all this from objective analysis. There is simply no possibility the genital bump(s) you are seeing are due to genital herpes. Period, full stop!
That concludes this thread. I hope the discussion has helped you. Best wishes and stay safe.
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