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STD Question
Drs Handsfield or Hook,
Thank you both for your time in providing this service.
For almost three weeks now, I've had an ulcer on my soft palate just to the right of my uvula. The ulcer developed 2 days after unprotected oral sex with another male. When the ulcer began to develop, there were no signs of blistering or vesicles, just a small white patch that began to grow to about 1 cm in diameter over time. While it is somewhat painful, its not as painful as other aphthous ulcers I've experienced in the past. There have been no other associating symptoms such as fever, lymphadenopathy or pharyngitis.
My partner is a black male and the extend of our sexual contact is mutual unprotected oral sex and protected anal sex. I've asked about his sexual history and he admits to having multiple partners where he only performs unprotected oral sex but always uses protection during anal sex. He admits to being infected with gonorrhea about 3 years ago for which he received treatment with Ceftriaxone and Azithromycin (providing Chlamydial coverage).
There are only a handful of conditions that I am aware that can cause mucosal ulceration when transmitted by the oral route. When the ulcer first developed, I passed it off as simple mucosal trauma and didn't think much about it, but what concerns me is the fact that its not healing as quickly as I would expect and the fact that this is the second time an ulcer like this has formed after my encounter with him (the first ulcer developed lower in my pharynx below the level of the tongue).
I've had no prior HSV symptoms (both genital or oral) and this does not strike me as a "classic" initial HSV outbreak. My other thought is syphilis, especially if ulceration can develop from re-infection multiple times. Chancroid seems unlikely. Again, this could be just simple trauma.
What are your thoughts?
Thank you both for your time in providing this service.
For almost three weeks now, I've had an ulcer on my soft palate just to the right of my uvula. The ulcer developed 2 days after unprotected oral sex with another male. When the ulcer began to develop, there were no signs of blistering or vesicles, just a small white patch that began to grow to about 1 cm in diameter over time. While it is somewhat painful, its not as painful as other aphthous ulcers I've experienced in the past. There have been no other associating symptoms such as fever, lymphadenopathy or pharyngitis.
My partner is a black male and the extend of our sexual contact is mutual unprotected oral sex and protected anal sex. I've asked about his sexual history and he admits to having multiple partners where he only performs unprotected oral sex but always uses protection during anal sex. He admits to being infected with gonorrhea about 3 years ago for which he received treatment with Ceftriaxone and Azithromycin (providing Chlamydial coverage).
There are only a handful of conditions that I am aware that can cause mucosal ulceration when transmitted by the oral route. When the ulcer first developed, I passed it off as simple mucosal trauma and didn't think much about it, but what concerns me is the fact that its not healing as quickly as I would expect and the fact that this is the second time an ulcer like this has formed after my encounter with him (the first ulcer developed lower in my pharynx below the level of the tongue).
I've had no prior HSV symptoms (both genital or oral) and this does not strike me as a "classic" initial HSV outbreak. My other thought is syphilis, especially if ulceration can develop from re-infection multiple times. Chancroid seems unlikely. Again, this could be just simple trauma.
What are your thoughts?
MEDICAL PROFESSIONAL
The frequency of new HIV infections is much higher in people with new syphilis and new HSV infections than those without them, and HIV is of course especially common in MSM. Further, all persons with documented or suspected new STDs (especially gonorrhea, syphilis, or herpes) should be tested for HIV. It's just common sense, and independent of exposure history.
hello ncboy33.
So sorry about your exposure. Hope you get well soon.
I wish really wish you would ask the good doctor why he is stressing that you be tested for HIV, since oral sex seems to carry negligible risk. This post has already created a fair amount of confusion in the HIV prevention forum and I think the confusion will grow if Dr. Handsfield doesn't elaborate on this matter. Thank you.
So sorry about your exposure. Hope you get well soon.
I wish really wish you would ask the good doctor why he is stressing that you be tested for HIV, since oral sex seems to carry negligible risk. This post has already created a fair amount of confusion in the HIV prevention forum and I think the confusion will grow if Dr. Handsfield doesn't elaborate on this matter. Thank you.
Follow up: cultures were done for gonorrhea, blood was taken for HSV, HIV and syphilis. They inspected the lesion but declined to do HSV cultures on it because the presentation didn't fit herpes (duration of over 3 weeks was too long) and they said the blood tests would pick it up anyway.
Rapid syphilis test was negative. They said it would certainly be positive if this were syphilis due to the duration of time the ulcer was present. All other cultures and blood work are pending. Looking at the lesion they would only comment that it appears "troubling" and asked that I follow up with an ENT physician as soon as possible. The blister on my lip from yesterday is beginning to resolve with no further issues.
This will be my last post to this forum. Before leaving I want to thank you again for your time and service. Your support and advice has been greatly appreciated. Best of luck to you in the future...
Rapid syphilis test was negative. They said it would certainly be positive if this were syphilis due to the duration of time the ulcer was present. All other cultures and blood work are pending. Looking at the lesion they would only comment that it appears "troubling" and asked that I follow up with an ENT physician as soon as possible. The blister on my lip from yesterday is beginning to resolve with no further issues.
This will be my last post to this forum. Before leaving I want to thank you again for your time and service. Your support and advice has been greatly appreciated. Best of luck to you in the future...
You have repeatedly said that Oral is not a risk for transmitting HIV but you are asking him to get tested for this, I do not understand?
MEDICAL PROFESSIONAL
Very small clear blisters that clear rapidly are not herpes. Every herpes outbreak has redness as well as blisters, and takes at least 10 days from onset to healing. So I doubt the small lesion near your lip is HSV. But I'm glad to hear you'll visit the STD clinic; I'll be interested to hear how things turn out.
I've made an appointment with an STD clinic tomorrow morning. This morning when I woke, I noticed a small, painful vesicular blister starting to form on the right side of my lip. I think HSV is more likely at this point, but there were previous encounters several weeks ago that would still keep syphilis in the picture. I'm also asking for HIV testing and throat cultures to evaluate for gonorrhea (though unlikely, but I'm having a bad day so you never know...)
Thank you for your concern. I'll let you know what they say as I get more information.
Thank you for your concern. I'll let you know what they say as I get more information.
MEDICAL PROFESSIONAL
Use the Post a Question link to ask a new question. Have your credit card handy for the fee.
MEDICAL PROFESSIONAL
By the time a lesion of primary syphilis (the chancre) has been present 3 weeks, 80-90% of patients have positive blood tests; so concern about blood test performance should not delay seeking medical care. Also, if this in fact was acquired during the exposure described, herpes becomes a more likely possibility, despite the atypical features for it -- and for herpes diagnosis by culture or PCR, earlier is always better. So you should not delay getting professionally evaluated. Please do it in the next couple of days.
MEDICAL PROFESSIONAL
Oops -- I missed the timing, only days since the last exposure. That's definitely too soon for syphilis. Nevertheless, the other features still make me concerned about that diagnosis, perhaps from an earlier exposure -- e.g if there was another oral exposure 2-6 weeks earlier. If it is related to the recent exposure, herpes becomes a more serious consideration, even though the single lesion and time course are atypical. In any case, my main advice is unchanged: see an STD provider and please come back with a follow-up comment about the outcome.
The exposure occurred July 29th and the ulcer developed 2 days following the exposure. It has been present ever since and shows no real signs of healing. There was no ejaculation into the mouth at the time of the incident.
Would syphilis and HIV testing be sensitive enough at this point to render conclusive results? I live in North Carolina.
Would syphilis and HIV testing be sensitive enough at this point to render conclusive results? I live in North Carolina.
MEDICAL PROFESSIONAL
Welcome to the forum.
This sounds very much like a chancre of primary syphilis, which fits with both the nature of the sore, its duration, the mild pain, and the type of sexual exposure. You don't say when the sexual contact occurred, which is potentially important; syphilis would be even more likely if the exposure was 10-30 days before the lesion began. Herpes is possible, but this would be a rather atypical presentation. Chancroid is more or less impossible; there have been no reported cases in the US for several years, other than a few imported from other countries; and I'm not sure oral chancroid occurs. Certainly I have never seen it.
My advice is that you promptly see an STD-knowledgeable health care provider, i.e. within the next couple of days. Your local health department STD clinic -- or its equivalent, if you are not in the US -- would be an excellent choice. Do not attempt to treat yourself with antibiotics or anything else before being examined.
Also, you need HIV testing (assuming you are not known to be HIV infected). Even though oral-genital HIV transmission is rare, overall this is a high risk scenario, especially given the possibility of syphilis transmission. If syphilis is confirmed, your partner of course will need to be examined and treated.
I'll be interested to know the outcome after you have been examined. Please return with a follow-up to let us know.
Regards-- HHH, MD
This sounds very much like a chancre of primary syphilis, which fits with both the nature of the sore, its duration, the mild pain, and the type of sexual exposure. You don't say when the sexual contact occurred, which is potentially important; syphilis would be even more likely if the exposure was 10-30 days before the lesion began. Herpes is possible, but this would be a rather atypical presentation. Chancroid is more or less impossible; there have been no reported cases in the US for several years, other than a few imported from other countries; and I'm not sure oral chancroid occurs. Certainly I have never seen it.
My advice is that you promptly see an STD-knowledgeable health care provider, i.e. within the next couple of days. Your local health department STD clinic -- or its equivalent, if you are not in the US -- would be an excellent choice. Do not attempt to treat yourself with antibiotics or anything else before being examined.
Also, you need HIV testing (assuming you are not known to be HIV infected). Even though oral-genital HIV transmission is rare, overall this is a high risk scenario, especially given the possibility of syphilis transmission. If syphilis is confirmed, your partner of course will need to be examined and treated.
I'll be interested to know the outcome after you have been examined. Please return with a follow-up to let us know.
Regards-- 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.
