[Question #8974] CSW Massage- Syphilis Risk

37 months ago

On 16 June I visited and was serviced by a CSW at an Asian massage parlor. I received brief condom protected oral sex from her (about 5 minutes or less). The condom was applied with her mouth and covered the majority of penis down to bottom of shaft.

I also has normal penetrative vaginal sex with her with the same condom lasting no longer than 6-7 minutes. Total encounter lasted no longer than 15 minutes as she had another customer who was waiting. I have regularly visited these types of establishments in the past and am generally aware or the low risk associated with safe sex practices with CSWs.

At exactly day 12, while self examining my penis for any abnormalities, I noticed what appeared to be a white raised hair follicle or Possible pimple ? with what appeared to be a white head of sorts and a long hair sticky out. It was located on the skin where my scrotum and shaft meet.

Probably not the best idea, using fine tweezers I removed the pubic hair from the follicle and then attempted to squeeze it with the tweezers. This caused some very superficial bleeding which was easily controlled. A day later (day 13) I had a small scab there which I assume is from my digging at it.

I am looking for some reassurance and thoughts on this experience to quell some anxiety. I have since visited both urgent care and my primary care provider (DNP). Both have performed a physical exam of my penis and stated there was nothing of concern. I was prescribed Mupirocin 2 % topical ointment by urgent care and was told to continue its use by my pcp. He stated if it was him he wouldn’t worry. I was also prescribed doxycycline for chronic ingrown hairs on my face , and was told I had possible Hidradenitis suppurativa

It is now going on day 20 post exposure, the spot is still there and is white in color. I’m not sure if this because the wound I created has just healed but it is visibly more white then the surrounding skin and therefore raises my anxiety. It’s definitely not any type of open wound and does not appear ulcerated just very very slight raised and all white. No pain or discharge.

My concern is syphilis, which I understand is unlikely. Was also hoping you could quell some of my concerns regarding my risk for syphilis from this encounter. I have yet another follow up with my PCP in two days (day 21) but would love to resume unprotected sex with my wife.

H. Hunter Handsfield, MD

37 months ago

Welcome. Thanks for your question.

I agree with the urgent care doc and your PCP. There is no realistic chance you have syphilis. Your description of the skin lesions is not typical for syphilis; it sounds exactly like a trivial, garden variety folliculitis or other superficial skin infection, or maybe a hidradinitis lesion. There is nothing in your further description of how the lesion has changed that hints at syphilis, and finally you had an exposure that was nearly zero risk for syphilis. Finally, you describe no enlarged or tender lymph nodes in the region, which by this time would be expected if you had syphilis.

If you would like to pursue the possibility of syphilis further, you can have a blood test at any time. Although it's early for a positive result, at 3 weeks up to half of newly infected people would have positive results, so a negative result would be at least somewhat reassuring. Conclusive testing can be done at 6 weeks. But in the meantime, I believe you should continue sex with your wife, which is what I would do if somehow I were in your situation. There really is no realistic chance you have it.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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37 months ago

Appreciate the quick response Doctor H!

Your thoughts definitely help the relieve some of my anxiety, which I know is the real culprit here.

Again, at this point I feel it’s more cosmetically unpleasing (probably because I can’t stop examining it) I would also assume that even in the very very unlikely chance I had syphilis the doxycycline I have been taking for my ingrown hairs would probably have killed the infection off at least some.

Lastly, am I safe to assume that if obvious HSV blisters haven’t formed by this point 20 -21 days in Im in the clear regarding hsv?

Thank you again. I shouldn’t have any other questions following your next response.

H. Hunter Handsfield, MD

37 months ago

I missed your comment doxycycline. If taking it at the time of exposure, acquiring syphilis was impossible. If taken afterward and you were infected, it would cure syphilis immediately.

Yes. There is no basis for concern about herpes.

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37 months ago

Lastly,

Syphilis lesions wouldn’t appear white in color? Or closed? And would typically be located towards head of penis.

Feel free to close after Dr H

Thanks

H. Hunter Handsfield, MD

37 months ago

Yes, most penile chancres involve the head or shaft of the penis. But it doesn't matter anyway. In view of the other information you have provided, the location and appearance of the lesion are irrelevant.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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