Cold sore or syphilis chancre?

[MatoGrosso]

Dear Sir

Firstly, my sincere thanks for all you do on this forum.

I am a guy in my late 30's.  For about 15 years I have had attacks of cold sores, sometimes several times a year, nearly always between my nose and top lip on one side.  For me, they often seem to be triggered by shaving or stress.

10 days ago I made the stupid move of seeing a CSW.  We kissed for about 10 minutes and then I received unprotected oral sex for about 10 minutes.  The lady concerned looked healthy and had no visible sores.

About 7 to 8 days after seeing her, I felt a tingle in my top lip, as usually precedes a cold sore, and this tingle was in the usual place.  Over the next 2 days a red raised area appeared as I expected.  There was slight itching and pain and I did sratch it once or twice.  Now I have two small areas (1-2mm across) where the surface skin has come off and it is slightly painful.  I also had some soreness in my throat.  I have noticed no other sores on my body.

However, the 'cold sore' is more swollen than usual and lower on my lip that usual.  It almost seems to be partly inside my lip rather than just on the surface.  The skin is also not quite as bubbly as normal, although I have been using Zovirax cream.  

Now I am in a terrible, terrible panic as to whether this could be a syphilis chancre.
  
If it is, what should I now expect after 10 days - will the chancre get suddenly much bigger?  
Or can I expect it to fade away within say 1 or 2 weeks?
What is the likelihood of it being syphilis?
Any thoughts at all would be most gratefully appreciated.

[Edward W Hook, MD]

Welcome to our Forum.  As I read your description, the first thing that comes to mind is that ,perhaps through scratching, your cold sore may have become infected with bacteria.  It does not sound like a chancre which typically would be both somewhat larger and, most importantly, painless.

Syphilis can occur at oral locations but it is VERY rare and typically occurs through direct contact with lesions.  If this is syphilis, a blood test would be positive at this time.  I doubt that this will be the case.  My advice would be to discuss this with a health care provider.  I suspect he/she may think that this would improve with antibiotics.  EWH

[Edward W Hook, MD]

So, to summarize, although there is no real evidence of an STD following your very low risk exposure you have taken a variety of antibiotics, some of which were given to you by a health care professional,  "just to be sure" and now you want to know if you should take more antibiotics without knowing if you ever had anything or not.  

I presume that at some point in this misadventure of inappropriate therapy you also were tested and the tests were negative.  If that is the case, I would suggest you stop medicating and move on.  If you have not be tested, then you should be (and should have been).  EWH

[MatoGrosso]

Dear Dr Hook

You very kindly asked me to update you on my situation.  I'll try to be brief:

1. Over the 48 hours after my previous post, the area of redness and swelling declined sharply.
2. The small (2mm) area where the skin had come off developed a scab.
3. After that, I have to admit that I took about 1g of azithromycin and about 400mg of Cefixime which I already had.  Forgive me, I was in a panicked state.
4. The scab cracked and bled a couple of times over the next 4 or 5 days but has now healed and disappeared.  
5. On Thursday I was able to see my normal doctor, who had been away.  He did not seem too concerned by my situation but did prescribe 100mg of Doxycycline, 3 times a day for 10 days as a precaution.
6. Although the scab has gone, I still have a triangular shaped area of slightly rough, slightly red, dry skin about 5mm across at the base and 5mm tall, by my top lip.  It appears to be slowly receding.

As you are an expert in these matters I wanted to ask just a couple more questions:

1. Would an additional, or more lengthy, course of doxycycline be advisable?  For example, another course in a month or two?
2. In the (hopefully) unlikely event that it was syphilis and the treatment failed, would a chancre or other symptoms reappear?
3. Do you feel that I can put this unpleasant situation behind me now?

Again, I thank you so much for all you do on this board.  It means a lot to so many people.

[Edward W Hook, MD]

Understood.  Please let me know what your doctor thinks.  EWH

[MatoGrosso]

Many thanks!  

I should point out that the red, raised, slightly swollen area is about 1.5cm across in total with just 2 small patches where the skin has come off, each of 1 - 2 mm.

I will talk to my doctor.

Thanks again.