STD Concerns

[mpw5167]

Hello Dr.

I am a 47 YO Male, about 9 weeks ago while on a business trip in NC a female massage therapist performed unprotected oral in my hotel room on for about 4-5 min. the next morning I had sores around the base of my penis that looked more like pimples or in grown hairs which I do get from time to time. I did read that no STD presents itself that quickly so I did not worry. Three to four days later I got a severe sore throat that lasted about a week, my Dr. gave me Z-Pak which I took as he thought it might me strep. About 7.5 weeks after the said incident I noticed another kind of hard red bump at the base of by penis in the same area, it is not open and nothing comes out of it but it has also been there for 10 days which is a lot longer than a usual in grown hair. My question is could this be Syphilis, I’ve read a Chancre will usually present itself at 3 weeks but the fact I was given Z-Pak could it have delayed it. If I was exposed would the Z-Pak have cured it. Should I get a blood test.

Thanks

[Edward W Hook, MD]

There is nothing in your posts that suggests that there is any reason related to the exposure you described to avoid sex with your wife. EWH

[mpw5167]

Dr Hook,

Just curious if you missed my follow up questions.

Thank you

[Edward W Hook, MD]

1. Based on you you last post is the Syph test conclusive.
yes


2. Although i understand Herpes is conclusive at three months I've read that 90% would show positive at 8 weeks is this accurate?
You were lucky you did not have a false positive test or find out that you had longstanding HSV that you did not know about.

Acquistion of genital warts through oral sex is very, very uncommon and when warts occur, it takes on average, about 6 months for them to appear.  Obviously I cannot examine you.  If you continue to worry, as seems to be the case, I would encourage you to ask a dermatologist to take a look.  EWH

[mpw5167]

Hello Dr.

Thanks for you response, I did decide to go with the blood test and have a couple questions. Since the lab a special for a complete panel I decided to do go with that. They did Clamadiya, Gon, Hiv, Herpes 1 & 2, Hep B & C, and Syphilis. Eveything came back Negative, this test was done at 9.5 weeks after the said exposure.

1. Based on you you last post is the Syph test conclusive.
2. Although i understand Herpes is conclusive at three months I've read that 90% would show positive at 8 weeks is this accurate?

The concern I have is that the bump is still there after three weeks and changes form from red and now almost white. What is the likely hood that it could be herpes or a genital wart. Are Genital warts usually singular like this or typically clusters? Can you even receive genital warts from rceiving Oral sex. If it is a wart do they go away on their own or does it have to get treated with soemthing? Final question, I recently had unprotected sex with my wife, have I potentially exposed her to something dangerous?

Thanks

[Edward W Hook, MD]

Welcome to the Forum. Sorry for the delay in getting you your question, I did not see it initially.  

I think your analysis about the lesions you describe being folliculitis are certainly the most likely source for  the lesions that you describe.  As you point out, the timing of the initial lesions was wrong for this to be an STD and you do have a history of similar lesions as well.

As for the possibility that this is a delayed presentation of syphilis, this too is unlikely.  Syphilis resulting from oral transmission is vanishingly rare and the few cases that are reported have occurred among men who have sex with me, not heterosexuals (even CSWs).  Further, while there are some strains of syphilis which are resistant to azithromycin, this too is uncommon and when you put these two unlikely situations together it makes the chance that this is syphilis very, very unlikely.  If you want to be completely sure, you could test for syphilis with a blood test at your local health department and put the possibility completely to rest.  If this were syphilis, the blood test would be positive at this time.

I hope these comments are helpful.  Personally, I would not worry at all.  EWH

[mpw5167]

Is there any reasons my question was skipped?