[Question #8358] Syphilis concern

45 months ago

I had a massage and hand job from a female provider. There was no other contact aside from the massage and HJ. I thought this was safe behavior but:

12 days later I found a single round lesion on the shaft of my penis. 2mm diameter. Ulcerated (white in the middle). Not painful. Would not describe as being firm or having a very defined rim
By day 15-16 the lesion had started to shrink and heal over somewhat. It formed a little scab that peeled off maybe 3-4 days after that
Day 17 my doctor prescribed me Doxi 14 days, 100mg 2x per day. I am taking this therapy. On day 9 now.
Day 25 today - the lesion is pretty much healed. Area still whiter than surrounding skin (blanched) but appears almost back to normal

I would like your help thinking about this objectively since I am anxious and guilty about a dumb choice. My questions:

1. Could you comment on likelihood this is syphilis?

2. If it was syphilis, how confident could I be in Doxi treament curing it?

3. Would you advise testing? If so what test and when?

4. Under what circumstances or timing could my wife and I have sex again? (we have not had sex since about a month before this incident)

Thank you!

Edward W. Hook M.D.

45 months ago

Welcome to our forum and thanks for your question. I happen to be on the side the time your question arrived so you are receiving a response much more quickly than it’s typical. Any follow ups may take longer.

It would be extra ordinary for the lesion you have noted on your penis to be due to Syphilis. Syphilis is transmitted only buy direct contact and would be possible only if your masseuse had an active syphilitic lesion on her head at the time you received masturbation. Receipt of masturbation is considered by most experts, including us, to be safe sex with no risk for acquisition of any STI. The lesion you describe sounds much more consistent with a pimple or simple cyst, both of which are relatively common occurrence is on the penis. In response to your specific questions:

1. See above. There is virtually no chance that the lesion you describe is due Syphilis.

2. Doxycycline taken twice daily for 14 consecutive days is highly effective therapy for Syphilis. If the lesion were due to Syphilis the doxycycline you’ve taken would be curative.

3. Personally, I see no reason for testing. If you wish to prove to yourself that the lesion was not due to Syphilis, a routine Syphilis blood test would be expected to be positive at this time, reflecting the infection which has now effectively treated. Blood tests typically remain positive for months or years after acquisition of infection despite successful therapy.

4. If the lesion was due to Syphilis, there would be no risk of transmission following completion of your doxycycline therapy. As I have already stated, I in confident that the leaves you described is not Syphilis and see no reason to abstain From unprotected sex with your wife at this time.

I hope the information I provided is helpful. If any part of my response is unclear where there are additional questions, please don’t hesitate to use you were up to two follow-ups for clarification. EWH

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45 months ago

Thank you very much for your perspective Dr. Hook.

I would like to make sure I have fully understood a couple points. Do I have this correct?

If I were to take a test, a negative blood test would confirm that Syphilis was never present (as you expect)
A positive test would show that it had been present (which we think is highly unlikely) ... but given the 14-day Doxy treatment it would be reasonable to move forward with life assuming the disease had been cured
Sex with wife OK because (A) high likelihood this was not Syphilis at all so there would be no Syphilis to transmit and (B) in the unlikely event that it had been Syphilis the Doxy would cure it and there would be nothing to transmit
"Cured" would mean the disease is not coming back (granted I accept that it probably was never there at all to begin with per your advice)

Thank you once again!

Edward W. Hook M.D.

45 months ago

Your summary is right on target. A negative test would prove that you were not infected with Syphilis. If you test positive that would mean that you had Syphilis but you could be confident that it had been treated by your course of doxycycline. Thus, there is no reason to hesitate to have unprotected sex with your wife. She is not at risk. EWH---