Possibly Syphilis?

I know this question is asked a lot on this forum, but I am anxious and need to ask. 29 days ago I had unprotected oral sex with a sex worker who has worked in the porn industry in Hungary where there has recently been well documented outbreak of Syphilis within the industry. A lot of porn starrs from there are reported to have contracted it in the summer. I became anxious as I had some irritation to the urethra and found it uncomfortable peeing about a week after and was tested (two weeks after the incident) for Gonorrhea and chlamydia both of which were negative. Roughly one week ago I noticed a reddening around one of my pearly penile pa pa-pules on my glands which spread to another Papule. Now I am seeing a small (1cm-2cm) round and defined spot covering bother the pa-pules which is now slightly raised and a little redder in color. The pa-pules are now obscured and it looks like there may be a defined ring around the spot although this is hard to tell as the skin in this are is not uniform. The spot seems to be flat on top.

1. Is this possibly syphilis or could it be something else?
2. How long does it take for a chanker to develope and what should I expect to happen now (ie how will it evolve) from what I have told you if it is indeed a chanker?
3. Will the blood test (if I go on Monday) be positive if there is a chanker present or do I have to wait a full 6 weeks from contact to be sure?
4.I have a long term partner. I am worried about passing anything on as we have had unprotected sex since the incident. How much should I worry that I may have passed the infection on?

I feel I made a very stupid mistake and hope this is nothing to worry about.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

In general, heterosexually transmitted syphilis is rare in western Europe.  But it's more common in central Europe, and there indeed have been syphilis outbreaks in porn performers -- so it's possible you had a high risk exposure.  On the other hand, although syphilis can be transmitted by oral sex, it isn't common.

The classic lesion of primary syphilis is a chancre, i.e. an open sore at an exposed site.  For this reason, and the ones implied above, it is very unlikely your papular penile lesion is syphilis.  (Or if it is, conceivably you have secondary syphilis resulting from a more distant exposure, i.e. at least 3 months earlier.)

My advice is that you shouldn't be trying to figure this out by this forum or any other online resource.  You need to see a health professional promptly.  If syphilis is considered at all possible, you need a blood test ASAP.  If you're back in the UK, visit your local NHS GUM clinic; or if you prefer private service, consider something like London's excellent Freedom Health clinic.  To your specific questions:

1) I doubt it's syphilis-- more likely a non-STD dermatologic condition such as lichen planus (or any of a hundred other possibilities).  But better safe then sorry.

2) Chancres typically develop 2-4 weeks after exposure, sometimes as long as 6 weeks.

3) In general it takes 4-6 weeks to develop a positive blood test for syphilis.  However, the test is generally positive within 1-2 weeks after onset of symptoms.  A negative result at this time will be moderately reassuring, but not proof.

4) Wait until you have a clear diagnosis before you worry about what, if anything, to say to your partner.

In person professional evaluation is more important than blood testing.  A knowledgeable GUM provider or dermatologist probably will be able to judge the cause by visual inspection more reliably than by any lab test.  So don't delay.  I'll be interested to hear the outcome after your professional evaluaton.

Best wishes--  HHH, MD

[JohnMarlow]

Thank you so much Doctor for your prompt and detailed reply. I will let you know how the Gum clinic goes on Monday - 30 days after exposure. I think it is most likely guilt, anxiety and coincidence that are causing me to see this as a worry, but as you say better safe than sorry.

Thanks again

John

[JohnMarlow]

Hello Doctor
I went to The local Gum clinic 4 weeks and two days after the possible high risk  exposure. I was examined and tested for syphilis. The health professional
said the spot was most likely a skin irritation. She seemed to think it could be the result of having sex and told me not to worry. Similar irritations have come up  since in a similar place where I have pearly papules and come and go. . The syphilis test also came back negative. I have been having regular unprotected (apart from a coil my partner has implanted) sex. I am not so worried now, but should I have another test at six weeks?  Thanks so much for your reassuring reply.

John

[H. Hunter Handsfield, M.D.]

I'm not surprised, but happy to hear there is no evidence of syphilis on examination.  However, if you want 100% assurance you didn't catch syphilis, you'll need a final test 6 weeks or more after the sexual exposure.

[JohnMarlow]

I have noticed I now have several of these same spots in different places on my penis head. Again they are red and round, but not particularly raised. It's starting to worry me again so I will go for another blood test for syphilis. This is now 8 weeks and I will be examined also.

Sorry to bother you again with this.

Does this sound like anything like an outbreak of syphilis?
How common are multiple sores?
My partner has a coil - could this possibly be whats causing this?

[H. Hunter Handsfield, M.D.]

Most genital/penile rashes are due to things other than STDs.  I'm quite certain it isn't syphilis, and probably entirely unrelated to either your partner's IUD or your adventure with the sex worker a few weeks ago.  I suggest you return to the GUM clinic for their expert evaluation.  I'm betting on something like lichen planus, psoriasis, or any number or other non-STD problems.

[JohnMarlow]

Hi Doctor. The gum clinic didn't seem to concerned about syphilis and recommend I don't get a blood test until the 90 day mark as then it should be conclusive. The doctor examined me and said there is nothing suspicious, but they will deal with these spots if they are still there in a month Although there was no diagnosis this was quite reassuring. .

From images it looks a lot like Lichen Planus. I read that this is itchy though and I don't feel particularly itchy down there.

There are multiple spots now all under a centimeter.

Thanks again Doctor

I'll post when I get my results at 90 days

[H. Hunter Handsfield, M.D.]

I have no other comments at this time.