Syphilis risk

[anthony33107]

Dr. Handsfield,

First, thank you for participating in this forum for such a reasonable fee.

I have a question, and yes, I did ask it on the regular STD forum already, but I am thinking I would be more confident in your opinion.

On June 19, I went to a massage parlor where the "massage therapist" sat her naked butt and vagina on my face and  performed "facesitting" on me. I don't think I licked anything, it is more of a smothering fetish. This lasted for maybe a couple of minutes. I'm sure her secretions got on my face, but I did not insert my tongue into her vagina.

Around the first week of August, I noticed a rash in my lower stomach/upper groin area. Also, it is on my chest, underarms, some on my back, and in some folds of skin. There is no rash on my palms or the bottom of my feet.

After I got this rash, I remembered that 2-3 weeks before that, I had a big pimple-like thing on the bridge of my nose, a little lower than where my eyeglasses sit. It's healed now, but there is a slight purple mark there now.

I went to the dermatologist last week and he biopsied one of the lesions from my abdomen area. The biopsy showed pityriasis rosea.

My questions:
1. What about the pimple thing? Could that have been a chancre on the upper side of my nose?
2. The pityriasis rosea diagnosis - is that a sure thing, based on the biopsy? I mean, it couldn't be syphilis beinbg misdiagnosed?

Thanks again for any help you can give me. I would have asked the dermatologist to reassure me regarding the biopsy, but he is a good frind of mine and I was embarrassed.

What a phenomenal service you offer here. And again, you could stand to raise the price a bit - I was expecting more like $40-$50!!

[Lifefighter]

hi thanks for writing this great info. I also experiencing the same thing. For me, I tought my condition was HIV, or Syphyllis condition. Now I am confident that my condition is the same as yours:-Pityriasis rosea.

Anyways,I will visit the dermatologist.I am sure now.

[Edward W Hook, MD]

thanks for the follow-up. Take care.  EWH

[anthony33107]

Just wanted to update anyone who read this post. A lot of times people seem to ask questions and they're obviously being influenced by anxiety and/or guilt, as I was.

I went ahead and got tested for syphilis in spite of being told that I didn't need it. And I was non-reactive. Testing was approximately 8-9 weeks after possible exposure and from what I read, that is conclusive, correct?

Hope this helps reassure someone or at least convince someone to get tested to relieve their anxiety.

[Edward W Hook, MD]

You have had definitive test- the biopsy.  You have pityriasis rosea, not syphilis.  EWH

[anthony33107]

Dr. Hook,

Thank you for such a quick and comprehensive response.

I guess I don't understand the difference between an ulcer and a pimple. The pimple-like thing on my nose did leak something when I squeezed - maybe blood, but I'm not perfectly sure.

But, if I am understanding you correctly, I have had a definitive test anyway, in the punch biopsy? This ruled out syphilis?

Is that correct?

Again, what a great service you offer here. Hopefully, I will not need it again!!

[Edward W Hook, MD]

Welcome to the STD Forum.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Years ago syphilis was referred to as the "great imitator" and medical students are still taught that when a rash appears, if you are not sure what might be causing it, you should do a syphilis blood test.  In addition, pityriasis rosea and the rash of the second stage of syphilis can resemble one another. Differentiation of the two can be accomplished in two ways- with a syphilis blood test and a biopsy.  While the two rashes can resemble one another, biopsy specimens look different and your dermatologist can distinguish one from the other. In addition, patients with pityriasis have negative blood tests for syphilis while persons with syphilis and a rash due to syphilis virtually always have positive blood tests for syphilis.  You have nothing to worry about.

In addition to having had a definitive test for differentiating the two problems, the rash you had appeared too soon after your contact to be the second stage of syphilis.  

Finally, the early stage of syphilis forms an ulcer, not a pimple and I note that on the STD Community site you report that you could express pus-like material from it.  This is not consistent with syphilis either.

Bottom line, while I can understand the concern, I can assure you that you do not have syphilis, based on your description of the "pimple", the time course of your symptoms and your biopsy results.  I hope this helps.  EWH