Could this be Syphilis

OK, about 3 weeks ago I received oral sex from a girl prostitute. I was wearing a condom. About 6 days ago I noticed a small cut about an inch up the shaft of my penis. The cut was small, like a pimple, maybe a little bigger than a pin head, and it was round. After a day it scabbed up. The scab fell off in the shower and it scabbed up again the next day. as of today it looks like it is healing, it definitly got smaller. Looking online I assume the only thing it could possibly be if not just a cut is syphilis. So I have a few questions.
1. What is the shortest amount of time a syphilis sore can heal in, I read it is 3 to 6 weeks, is this true or can it heal in 5 - 6 days?
2. Can syphilis sore be slightly larger than a pin head in size, all the photo's I have seen online seem to be much larger than that?
3. What is the difference between a sore and a cut? And does a Sore form a scab?
4. Could this be anything else?

[H. Hunter Handsfield, M.D.]

Syphilis is rare in commercial sex workers. so catching it during the exposure you describe is extremely unlikely, especially with the condom.  (There are only about 20,000 cases of syphilis per year in the entire US, and three quarters of those occur in men who have sex with men.)  If your sex worker partner is African American in a southern US city, or if she is Mexican in the border areas of the southwest, there is an increased chance she had syphilis.  Otherwise, there is almost no chance.

And although the timing of onset of your penile lesion is consistent with syphilis, your description of the lesion is not.  To the specific questions:  1) The chancre (the initial sore of syphilis) usually heals in a few weeks; 5 days seems too soon (but I cannot say it is impossible).  2) Small lesions are possible.  3) The chancre of syphilis usually is quite firm, even feeling hard to the touch.  Your lesion doesn't sound like that.

What else could it be?  Herpes.  You give a pretty good story for an episode of recurrent genital herpes, but probably not new herpes that you caught during the oral sex event.  Most likely you just had a pimple, since pimples are quite common on the penis.  But if a similar sore reappears any time in the future, see a provider right away (within a day after it appears) for professional evaluation.

Finally, if you remain nervous about syphilis, have a syphilis blood test in about 3 weeks, i.e. around 6 weeks after the oral sex exposure.  You can expect it to be negative.

Regards--   HHH, MD

[bigguy910]

Just another quick question.

The cut is dry and has been for two days. It looks healed however I can still make out a circle and inside the circle it looks like it could be a very small scab. Would a Chancre dry up or does it generally stay wet?
"Open sore" I take to mean wet or fresh looking not scabbed am I correct in that assumption?

Thanks again

[H. Hunter Handsfield, M.D.]

A chancre would not behave that way and probably not herpes either.  However, a scab cannot appear unless there is a break in the skin before the scab appears, so maybe a lesion was there before you noticed it.  You are a better judge of this than I can be. Yes, that is what I meant by open sore.  But even open sores eventually heal with scabs.  At this stage your detailed description of the lesion makes no difference in my guesses about the cause.

Please re-read the last 2 paragraphs of my initial reply and act accordingly.  I can't help any more than that.

[bigguy910]

Hey Just an update, and another quick question

OK I took your advice and had a STD test done which came back negative for everything.
A doctor friend of mine told me because not enough time had went by it could still possibly be an STD. since there was no other explanation for what was on my penis he prescribed me Doxycycline twice a day for ten days to be sure, and he said that should clear up anything that it may be.

I completed the 10 days of Doxy and three days after that, Today, I noticed what appears to be a pimple on my penis. it's very small, round, and has a firm white head.  On Wedensday I am going to a dermatologist. I hope it's still there.

Here's the question part.

I had sex during the doxy treatment with a condom, and then without a condom after the treatment. both with my girlfriend. I also had sex with her shortly after the exposure, before I noticed the sore/cut on my penis.

Is it possible that I did have something, and was cured, then got it back during my doxy treatment, or right after I completed it three days ago?

OR

Is it possible that it was an STD that did not show up on the test and was never cured, and does Syphilis produce a second Chancre sometimes?

Please I am nervous as hell and would love your input. I trust your jugement as you probably have way more experience in this area than most doctors.

Again this looks more like a pimple, and as of now is not open. I have been checking myself 3 or 4 times a day since this happened so I know for certain that today was the first day this pimple appeared. Also I don't know if this is in my head, but, the pimple seemed larger at 4:30PM when I found it than it looks now 3:00AM

Please Doctor any help will be so appreciated

[H. Hunter Handsfield, M.D.]

Most likely the initial problem was not an STD of any kind.  In my opinion, it was a mistake to take doxycycline without a clear diagnosis or stronger evidence that you had anything that would respond to antibiotic treatment, especially from a medical friend who probably did not do a formal medical evaluation.  But if you had syphilis, the doxy would have cured it, or at least suppressed it; there is no chance that the sore/pimple that appeared later was due to syphilis.

Seeing a dermatologist is a good plan.  Pimples occur all the time on men's penises.  If the more recent lesion looked like a pimple, that probably is what it was.  But I certainly cannot rule out the possibility that it was herpes.  If "checking myself" 4 times a day means you are handling or sqeesing the lesion, you're probably making it worse and also harder for the dermatologist to accurately evaluate it.  So keep your hands off before you see the dermatologist.  And do not take any more antibiotics.

I might have another comment if you want to come back to post the outcome of your visit to the dermatologist -- but not until then.

[bigguy910]

I saw a dermatologist just now.
Thje pimple was smaller still.

She said that it is probably just a pimple or maybe folliculitis.

she prescribed an antibiotic ointment and told me to stop worrying.

Just to be safe I will get another std test in about 2 weeks.

Thank you doctor.

[bigguy910]

also as a note I was checking my penis for lesions of any kind everyday, because I was nervous. I did not have anything on my penis until yesterday at 4:30PM. I also made sure not to touch it so it was in perfect shape for the dermatologist.

Instead it shrunk to next to nothing.

My luck!