Syphilis/STD's from Russian Hooker

[Bushmills]

Dear Doctors,

I’m a single, heterosexual male (40 yrs old) living in Chicago. This past June 3rd I got drunk as hell at a neighborhood bar, and as usual, stumbled home without a girl. I decided to call an escort and an hour later this SMOKIN’ HOT Russian chick shows up at my door. I mean she was dynamite. She put a condom on me, sucked the daylights out of me, and then inserted me inside of her…ya know…vagina. Being conscientious about safe sex, I’m sure the condom remained intact the whole time.

Approximately 3 weeks later I noticed a single firm red lump (around the size of a pinto bean), about an inch below my waist line and 2 inches above my genitals (in the pubic region). I immediately thought “Oh great”. Over the course of the next 2 1/2 weeks I inspected, detected, rejected, and neglected this thing until it simply went away. The lump in question was red, appeared out of nowhere, never opened or ulcerated, was painless, shrunk in size everyday, seemed to be “under” the skin, and as stated before… simply went away.

So here are my questions:

1) Could this be an “atypical” Syphilis chancre? Seems to me the only thing that jives with a chancre is the 3 week timing of it popping up. Being in an unusual spot, and the fact that it never ulcerated makes it (hopefully) unlikely it was.
2) Do chancres ALWAYS ulcerate? I know Syphilis can be deceptive at times.
3) The chick was Russian… does that make a difference seeing how Russia has high incidences of Syphilis?
4) Being the sex was fully protected should I be concerned with HIV or any STD?
5) And finally what do you recommend my course of action be where testing is concerned?

I look forward to your response.

Thank You!

[Edward W Hook, MD]

Welcome to the Forum.  The lesion you describe was most probably a folliculitis lesion or simple cyst, totally unrelated to the exposure that you have described.  Waiting it out as you did was precisely the right thing to do.

As we say a lot on this Forum, condom protected sex is safe sex, most commercial sex workers do not have STDs, including HIV (bad for business), and most exposures to infected partners typically do not lead to infection.  I would not be worried that this was an STD and see no reason for concern or for testing.

As for your specific questions:
1) Could this be an “atypical” Syphilis chancre? Seems to me the only thing that jives with a chancre is the 3 week timing of it popping up. Being in an unusual spot, and the fact that it never ulcerated makes it (hopefully) unlikely it was.
You are correct that the timing might be consistent with a syphilitic chancre but the likelihood that this is what this was in miniscule.  *** you point out, the location is atypical and syphilis is a rare infection, particularly among heterosexuals.

2) Do chancres ALWAYS ulcerate? I know Syphilis can be deceptive at times.
See above.

3) The chick was Russian… does that make a difference seeing how Russia has high incidences of Syphilis?
But this was not Russia, her country of origin should not cause  concern.

4) Being the sex was fully protected should I be concerned with HIV or any STD?
Nope.

5) And finally what do you recommend my course of action be where testing is concerned?
Personally, I would not be worried.  If you would feel better from the reassurance that testing would provide, had this lesion been syphilis, your syphilis blood test certainly would be positive at this time.  I see no reason for other testing.  EWH

[Edward W Hook, MD]

Still no realistic risk.  No change in my advice or suggestions.  EWH

[Bushmills]

Dr. Hook,

Thank you for the prompt reply.

I'm sorry I wasn't clear as to question number 3. The chick was actually from Russia (here "On Tour" I guess) and she's back there now. I actually know that for a fact - If that makes any difference?

Anyhow, I really appreciate your time and the professional advice you provided.

Thank You again!