STD? Syplilis

I first felt a hard lump on the right side of my frenulum in early september . In september 27 I visited a mssage house and received 30 seconds unprotected oral sex. Then In October 19 about 2 or 3 days after very rough sex with my usual sex partner I developed a partial swelling under my foreskin and I could see it only if I pulled the foreskin back. The swelling is on the right side and about 2 cm in lenght paralled to and roght under the coronal sulcus. The next day I saw light white/creamy discharge from the area. I could use tissue to absorbed the discharge and if I pressed the area there would have small amount of blood followed by clear fluid. The whole area was wet like and had a foul smell like urinated. The smell was strong even on my fingers after I toughed the area and wahed my hand. I saw a very small leison not large than 2mm if there was the one.

It seems to me I saw the same discharge right after my last sex with my usual partner.
  
I went to see a famaily doctor on Oct 22 and according to clinical observation and sex history I was treated by 2.4m penicillin. Tests were ordered and all came back negative including RPR. DURING THE NIGHT I DID EXPERINCED FEVER, CHILLS AND JOINT PAIN the typical JH Reaction happened on syphilis treatment. This worried me.

On October 23, there was a 3mm x 2mm x 2mm cream color mass came out through a passage right on the junction of frenulum and sulcus. The lump I mentioned earlier disappeared. I went for another RPR test on Nov 15 the result came back nonreactive.

Did I catch syphilis? A follow up FTP-ABS? Tks

[H. Hunter Handsfield, M.D.]

No, you didn't catch (and don't have) syphilis--based on the information above and in the clarifying comment that follows this one.  The clinical presentation doesn't sound like syphilis; if you had syphilis, the penicillin would have cleared it up; the continuing negative syphilis blood test (RPR) rules it out; and the chance of catching syphilis from a single, brief oral exposure (especially heterosexual) is extremely low.

So the only thing slightly in favor of that diagnosis is the reaction following penicillin, which from your description indeed sounds consistent with a Jarisch-Herxheimer reaction.  (For other viewers, JHR results when penicillin starts to work against Treponema pallidum, the bacteria that causes syphilis.  As the billions of organisms in your body die, they release toxins that cause the reaction.)  The same reaction can occur after starting treatment for other infections; i.e., although classically described with syphilis, in this case it is clear syphilis isn't present.  It also could have been an allergic reaction  to penicillin; in fact, if I were you, I would avoid penicillin in the future unless there simply is no other suitable antibiotic--which with all the antibiotic choices now available is rare.

As to what you actually have:  This sounds most like a recurring infection of a sebaceous cyst or perhaps a congenitally patent median raphe duct.  This is a fairly common and generally trivial congenital malformation that results in a blind duct on the underside of the penis, typically opening with a small pore anywhere from a couple of millimeters to an inch or so from the meatus along the underside of the penis.  Recurrent infections are common, often only prevented by surgically removing the duct.  Alternatively, an infection of normal penile glands, such as Tyson's gland (all men have 2 of them, opening on each side of the meatus).

In any case, you don't have syphilis, and the standard bottom-line advice applies:  ask your health care provider.  If a patent median raphe duct seems possible, a urologist would be a good bet.

Happy holidays--  HHH, MD

[Con237]

Date correction: I visted the massage place on October 27. Foreskin swelling started on Novement 19. Got STD tested and TREATED on November 22. J-R reaction on November 22. STDs test results negative on Novemebr 23. Mass/lump voluntarily excised on Novemebr 23 and all symptons disappered by November 26.

Another RPR was done on December 15 and was nonreactive.

Should the PRP test of Dec 15 turned positive becasue of existence of antobody after treatment if I had caught syphilis on October 27. Should I concern the J-R reaction?

Sorry for the date confusion and error. Thanks again.

[Con237]

Dear Dr,

Thanks for your time. I really appreciate it.

I may make a confusion in my original message:

"It seems to me I saw the same discharge right after my last sex with my usual partner." This happened 2 or 3 days before my first discover of partial swelling foreskin on November 19 but not after treatment.

Also just want to confirm my understanding. If I had syphilis, the second RPR blood test result should turn positive and the titres would elevate becuase of the existence of antibody due to treatment? Will make good to have another specific blood test like FTA-ABS to rule out syphilis?

I have been through a lot of anxiety in the past month. Lost weight and sleep. I have not had sex with my girl friend since this incident and am still struggling to see if I should tell her I may have caught syphilis though the test results came back negative.

Many thanks and happy holidays.

[H. Hunter Handsfield, M.D.]

The point about RPR testing is that the result is always positive if the disease is active.  That is, if one or more tests were done at the time you had your penile lesion, then the negative result--especially when confirmed with a second test--is definitive evidence against syphilils.

I doubt you need to avoid sex, and don't believe this issue is worth a lot of anxiety on your part.  Get checked out as suggested in my original response, but don't let this make you crazy.  I am quite certain there is no STD involved.

Happy new year--   HHH, MD