I recently received brief oral sex (maybe a minute) with the same girl from my previous queries. I have recently noticed a maybe 2cm oval patch of dry skin on my penis. This flaked off and left a red patch. It’s not sore, there has been no ulcer and no lump or dent. The red patch then covered over with dry skin again, which flaked off leaving a very red patch again. This has happened about 3 times over the past 10 days.

I went to see my dr today who advised this could be a syphilitic chancre or a fungal infection. He’s referred me for a blood test next week. I have already done a private blood test last week (EIA) which came back negative. Here’s a full timeline:

4th March - Brief unprotected oral

16th April - first noticed the red patch

19th April - Took EIA test (neg results received on 21st April).

25th April - Doctor appointment

Doc said he thinks that there’s prob a 30% chance of syphilis (he’s aware of my recent test result). I should mention that when he examined me today he said the patch resembled more of a fungal infection, it’s more photos I showed him from the past 10 days that made him think of a chancre.

How probable do you think it is that I have syphilis? When would a test be conclusively negative? The test I took last week was at approx 6.5 weeks and the patch developed at 6 weeks. Would the test I’ve already done be considered ok? And would the test I have next week, if negative, be conclusive or would I need a follow up? 

Given what you’ve told me before and the fact there were no visible sores on the lips of the girl would it be reasonable to assume that the assessment of 30% chance is off the mark or do you think I could have contracted something?

1.  Penile chancres develop. on average, three weeks following an exposure.  The more than 5 week interval between March 4 and April 16 is far too long to be a syphilis chancre.

2.  The lesion you describe does not suggest syphilis.  Syphilis lesions do not flake off and then recur- this is more suggestive of a fungal infection or other dermatological process.

3.  Your blood test was negative 4 days after you first noticed the lesion.  Most typically it would be positive at this time.

4.  Your partner, who you have been with in the past, is an unlikely person to have syphilis as Dr. Handsfield informed you in past threads.  Most syphilis now occurs among men who have sex with other men, not women and syphilis from receipt of oral sex is relatively uncommon.

I am confident that this is not syphilis.  If the test you have next week is negative, you can be completely confident that this is not syphilis.  I suggest that you see a dermatologist.  EWH

Thank you, Dr Hook. That's good to hear!

I've decided to purchase a test where I can collect a sample at home and send it to a private lab. As much as I realise how privileged I am to have the access to the NHS, it can take 2 - 3 weeks to get results at the moment whereas a private test will give me a result within 72 hours. If I were to take the test tomorrow, would that be as conclusive as waiting an additional week to take the one I have been referred for?

The lesion has once again progressed from being red to predominantly covered in white flakey skin (a bit red/pink in the areas that aren't flakey and in between the cracks). I'm assuming this will peel and leave a red patch again. I understand why my GP thought the pictures of the red lesion looked like a chancre, there is a resemblance in the absence of the flakey skin. However, knowing that chancres never flake off has made me feel a lit better. Am I also correct in thinking that a chancre would never be totally dry? I've experienced no weeping or wetness of any kind (well, not that I've observed).

If I may, based on your assesment, percentage wise, how confident are you that my next test (whether tomorrow or next week) will be negative? Would it be presumptuous to assume in the upper 90% range?

Many thanks

Being seen at a NHS clinic will benefit you by being examined by a health care professional familiar with genitourinary medicine.  The benefits of this are substantial.  Getting tests at the private lab will also provide additional information soon.  Doing both might help you to move forward 

If you take another test tomorrow and it is negative, as I am confident that it will be, this will prove that your penile lesion is NOT syphilis.  I say this with complete confidence.  EWH

The results from the private sample I sent last Wednesday (26th) came back negative as you predicted. I was due to go to my NHS appointment today but unfortunately my train was cancelled and it’s had to be rescheduled to next week.

I presume your advice about attending this appointment was more to ease my mind more than anything else? With the time scale between the incident and my test last week would you deem this most recent result to be 100% conclusive? Is it necessary for me to attend the rescheduled appointment or would I be ok to skip this and resume sex with my partner?

Many thanks

with all due respect to your GP, I believe he has misremembered how long it takes for a blood test to be conclusive. The average time for a lesion to appear following an exposure is three weeks and results of syphilis blood tests are completely conclusive anytime more than six weeks following an exposure.

As you know, we provide up to three responses to each clients questions. This is my third response. Therefore, shortly this thread will be closed without further responses. Once again, I urge you to move forward without concern. Take care. EWH.