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MEDICAL PROFESSIONAL
I believe you have syphilis; I could use your description of the penile sore to each medical students about chancres, the ulcerative primary stage of syphilis. The same applies to parts of your skin rash description, especially lesions on the soles of the feet and in the mouth. And you clearly are at risk, by having sex with other men (oral sex easily transmits syphilis). Usually the generalized rash of syphilis (the secondary stage) doesn't appear until the chancre has healed, but there are many exceptions. Regardless of your dermatologist's opinion, you definitely need a syphilis blood test if not yet done. (If s/he knew about your bisexual contacts, s/he should have jumped to the possibility of syphilis just as I have.)
Herpes is the most common cause of genital ulceration, but the lesion you describe doesn't sound like herpes, both from your description of the lesion and its duration. From the timing, I can't tell whether inflammation from podofilox might be responsible. Finally, every condition that can cause rash or other skin abnormalities anywhere on the body sometimes can affect the genitals, so the possibilities are broad.
So if you have an STD at all, it's syphilis. Get that checked out right away if a blood test hasn't been done. The most efficient way probably is to visit your local health department STD clinic for expert, confidential care. They'll be able to make an accurate determination for or against syphilis within an hour, while you wait. And if it's syphilis, have an HIV test as well. But if/when syphilis is ruled out, follow the STD clinic's and/or your dermatologist's advice about other possibilities.
Good luck-- HHH, MD
Herpes is the most common cause of genital ulceration, but the lesion you describe doesn't sound like herpes, both from your description of the lesion and its duration. From the timing, I can't tell whether inflammation from podofilox might be responsible. Finally, every condition that can cause rash or other skin abnormalities anywhere on the body sometimes can affect the genitals, so the possibilities are broad.
So if you have an STD at all, it's syphilis. Get that checked out right away if a blood test hasn't been done. The most efficient way probably is to visit your local health department STD clinic for expert, confidential care. They'll be able to make an accurate determination for or against syphilis within an hour, while you wait. And if it's syphilis, have an HIV test as well. But if/when syphilis is ruled out, follow the STD clinic's and/or your dermatologist's advice about other possibilities.
Good luck-- HHH, MD
Thanks, Doctor. I'm about to take myself asap to a clinic (though it's Sunday, so I don't know if I'll find anyone open). What are the odds of contracting HIV through receptive unprotected male oral sex?
Thanks.
Thanks.
Sorry, one more question: I told my dermatologist about receiving unprotected male oral sex and suggested syphilis myself but he didn't see that as a serious possibility. Should I change doctors?
MEDICAL PROFESSIONAL
If I correctly recall a recent report, something like 40% of syphilis in gay/bi men in the US currently is being acquired by unprotected oral sex. The oral lesions if secondary syphilis--such as the spots you have seen in your mouth, if you have syphilis--are teeming with syphilis bacteria and highly infectious.
There's not that much urgency. Wait until Monday and visit your local health department. Any place you could find open on Sunday (emergency room, urgent care clinic) is not likely to be staffed by people who know much about syphilis.
Most dermatologists are pretty well trained in STD and certainly should know the routes of syphilis transmission. By itself, that doesn't need you need to change doctors. But an STD clinic or other provider confirms syphilis, make sure you let the dermatologist know about it.
HHH, MD
There's not that much urgency. Wait until Monday and visit your local health department. Any place you could find open on Sunday (emergency room, urgent care clinic) is not likely to be staffed by people who know much about syphilis.
Most dermatologists are pretty well trained in STD and certainly should know the routes of syphilis transmission. By itself, that doesn't need you need to change doctors. But an STD clinic or other provider confirms syphilis, make sure you let the dermatologist know about it.
HHH, MD
Maybe I misunderstood your question about oral sex. You might not be using "receptive" the way I mean. Performing fellatio (receptive) is lower risk that receiving it (insertive). Given the penile lesion, you probably were infected by being the insertive partner.
HHH, MD
HHH, MD
Sorry, Doc: One final thing as I'm not sure if I had my terminology wrong regarding "receptive male oral sex." I was the one inserting the penis (not taking it in my mouth). I assume this doesn't change your opinion?
Thanks for all the great advice.
Thanks for all the great advice.
MEDICAL PROFESSIONAL
Right. Now we're on the same track.
HHH, MD
HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
