Possible Symptom

[YOURANSWERPLEASE]

I didn't really think of this as a possible symptom or concern until recently when I was reading about Syphilis on the Internet. I am now concerned and would like your input.

I have a hard white/red spot about the size of an eraser head in my mouth on the lower right side about half way back and below my teeth line. It is just about where the bottom of the teeth/jaw meets the floor of the mouth. It often appears to have an ulcerated center. It has been present for about 6 months or perhaps a little longer. It is essentialy unchanged over that time. It only hurts if I spend time poking/pushing. It has been evaluated by an ENT who didn't seem concerned, however, his focus was on oral cancer. The topic of an STI was never discussed.

As noted above, I wasn't thinking of an STI until I started reading about Syphilis. I am now concerned this could be a Syphilis chancre. The exposure would be a deep french kiss with a woman other than my wife which occurred in a club about 7- 8 months ago. I have read that syphilis can be spread via french kissing. Of course I recognize that french kissing is a fairly common activity, however, I have strong reason to believe this woman is very promiscuous. I also acknowledge very mixed feelings regarding my kissing a woman other than my wife.

The mouth spot remains, however, I don't believe I have shown any other symptoms. I presently have 2 or 3  very itchy areas of dry skin which might be exczema.

Is my french kissing incident something to be concerned about and should I ask my doctor for a Syphilis test or any oher STI testing. I am scheduled for an annual physical in a few months, I am also sure I could get an earlier appointment for testing if necessary. Thank you.

[H. Hunter Handsfield, M.D.]

Your internist is right.  Your obsession about syphilis is quite irrational.  Consider asking your internist whether it relfects a mental health issue that should be evaluated and/or treated.  I suggest it out of compassion, not criticism.

HHH, MD

[YOURANSWERPLEASE]

Monkeyflower thanks for the kind words. I have put myself in a bad place andI am upset. The ENT specialist didn't think the white spot was anything to bo concerned about. I think that is part of the reason I am not too concerned about other oral issues.

The syphilis issue seems very real to me. I showed it to my family Internist and he said it didn't look like a chancre. He also said a chancre wouldn't last 6 months. He also said the glands in my neck were not swollen. He examined me on Wednesday and suggested a blood test for my peace of mind. I think the results will be available on Monday. He said if I spent any time worrying I was wasting my time. I of course have been spending a great deal of time worrying. In addition I have found a white spot on the side of my tounge and I am concerned this is a sign of secondary syphilis. This would be the first sign of secondary syphilis as I don't remember having any rash on my palm or soles of my feet. I do have sometimes itchy spots on my hips which I think are excezma, however, I am now starting to worry and wonder about almost everything. Perhaps this is anxiety talking.

[YOURANSWERPLEASE]

I did read Dr HHH's reply a number of times and I wish it was easy to simply share your interpretation. I have read some conflicting information regarding whether a chancre does heal on its own or can last many months. Perhaps you have additional information or experience which will put your read of the Docs comments in context.

[monkeyflower]

I think it's interesting that you're more worried about syphilis - a highly unlikely diagnosis - than oral cancer. But in any case, relax. I think Dr. Handsfield clearly states that the risks are minimal: "Syphilitic chancres almost always resolve spontanously within a few weeks; 6 months is much too long", "...although kissing an woman can be a source of syphilis, it is an extremely rare event", "...the odds are very low."

You're stressing out over nothing. Get tested so you feel better, but don't let your guilt overwhelm you in the meantime. Jeez, it was just a kiss :-)

[YOURANSWERPLEASE]

I took your advice and followed up with the ENT specialist. I told him of my concerns regarding syphilis. He told me the area didn't really look like a syphilis chancre, however, in light of the kiss history he recommended a syphilis blood test. He wasn't able to tell me anything about other symptoms to look for and he was somewhat non-committal when I asked him if a syphilis chancre would have healed on its own by this time. He did say that the time between the kiss and the appearance of the symptom is about right for a chancre. He felt all of the glans on both sides of my neck and told me that none were swollen. He also told me that the area had not changed in appearance from the 2 prior times he examined my mouth in October and January.

I would very much like to know if any of this information rules in or out a diagnosis of syphilis. He told me it will take 2-3 weeks for the blood tests to come back. I'm not sure if I am on the correct path, perhaps I should locate an STI specialist/clinic or my Internist.

Thanks for any help you can provide.

[john989]

I was actually surprised to read how low the rates of syphilis are in my area. The stats were on my state's websites

I thought that might have been a possibility but I would be shocked after reading the rates.

[YOURANSWERPLEASE]

Dr Handsfield;

  Thanks for the response. I am very anxious now that it seems you consider syphilis a possible explanation for my mouth symptom. I made an appointment with the ENT for later this week as I remained concerned the spot hasn't gone away. I don't know if syphilis chancre in the mouth is something in his area of practice.

I am not scheduled for my annual physical for 2 months. I am now starting to wonder if I should avoid contact with my wife. I am also starting to read about symptoms and examine myself for other signs. I really don't have any other symptoms except the fact that the white spot has gotten a little larger over the last 6 months. I also have numerous dark spots on my back, however, my wife says they are age spots which have been present for a long time. I never considered them before, however, they do look like age spots/freckles. I find that if I look at it long enough my head fills with doubt. I do wonder if this is all my anxiety/guilt talking.

Based upon your reply should I now avoid intimate contact with my wife and should I contact my Internist for an immediate appointment. Also in your experience are most big city Internists well versed in STI diagnosis or should I go to a clinic. Also what other symptoms should I be looknig for and monitoring. Thanks.

[Imdumb]

Read what the doc said again.  There is no way you have syphillis.

[YOURANSWERPLEASE]

Dr Handsfield;

Thanks for the response. I am very anxious now that it seems you consider syphilis a possible explanation for my mouth symptom. I made an appointment with the ENT for later this week as I remained concerned the spot hasn't gone away. I don't know if syphilis chancre in the mouth is something in his area of practice.

I am not scheduled for my annual physical for 2 months. I am now starting to wonder if I should avoid contact with my wife. I am also starting to read about symptoms and examine myself for other signs. I really don't have any other symptoms except the fact that the white spot has gotten a little larger over the last 6 months. I also have numerous dark spots on my back, however, my wife says they are age spots which have been present for a long time. I never considered them before, however, they do look like age spots/freckles. I find that if I look at it long enough my head fills with doubt. I do wonder if this is all my anxiety/guilt talking.

Based upon your reply should I now avoid intimate contact with my wife and should I contact my Internist for an immediate appointment. Also in your experience are most big city Internists well versed in STI diagnosis or should I go to a clinic. Also what other symptoms should I be looknig for and monitoring. Thanks.

[H. Hunter Handsfield, M.D.]

In case it isn't obvious, the first line in my response is supposed to read "Syphilitic chancres almost always resolve...".

HHH, MD

[H. Hunter Handsfield, M.D.]

Syphilitic chancres almost resolve spontanously within a few weeks; 6 months is much too long.  Further, although kissing an woman can be a source of syphilis, it is an extremely rare event, especially with syphilis as rare as it is today in heterosexual women in most populations in the United States.  But other than the duration, your description is not unlike that of a chancre--so, sure, have a syphilis blood test during your next routine health exam.  It can't hurt.  But the odds are very low.

From your description, I too would worry about oral cancer, so follow through with the ENT doc (or another provider) if the lesion persists.  (If he really was worried about oral cancer, he probably would have biopsied the lesion and you would know for sure what it is.)

Good luck--  HHH, MD

[Imdumb]

In the U.S. Syphilis is rare amoung heterosexual.  I think last year in the whole country there were only 8000 cases.  Most of those amoung men who has sex with men.  French kissing is not really a syphilis risk.  I remeber the doctor responding to this once saying that out of the 8000 cases lat year, he would think zero would come from kissing.

[bigdaddy1992]

Hi,i am not the doc but i have read extensively about syphillis and followed this forum for some time. What i have read is that if you have had this for 6 months and it was unchanged then it is highly unlikely to be a syphillis chancre. I think an ENT specialist would also be able to recognise a chancre so i would say you need to see your doc to find out what it is, but i think you can discard syphillis as a cause.