Secondary Syphilis Symptoms

[Platformer]

Dear Dr.

I am concerned that I may have contracted Syphilis. In March of this year I had protected intercourse with a CSW in Thailand. After returning home I noticed a very faint spot on my penis. It was an oval shape and the outline looked similar to the shape of a Syphilis sore but it was so faint it didn’t even seem like anything to be concerned about.

About two months later I got a two spots on my arm and one on my upper neck that turned into ulcers that took a long time to heal. I actually wrote into the Derm expert because I was concerned that they were Ecthyma or some bacterial infection. These sores healed slowly over two months and by the time I got to see my Derm they had healed into red bumps. My doctor said he didn’t know what they were but he doubted a bacterial infection. Lately a few more of these ulcers have sprung up on my arms and are taking a long time to heal.

Most photos I have seen of Secondary Syphilis look more like a widespread rash involving the whole torsos as well as the soles and palms. But I have seen a few images of more solitary ulcerative lesions on the torso similar to what I have.

In your experience does Secondary or Tertiary Syphilis ever manifest as solitary ulcerative lesions on the torso and arms?

Does Secondary syphilis ever last for five or six months before turning into latent Syphilis?

I am going to get tested in the next week regardless I just wanted some idea of my chances.

Thanks

[Edward W Hook, MD]

There is a chance that your cultures for STaph will be negative because of the antibiotics you are taking.  that would be OK if the keflex is making them better however.

As for syphilis, you are correct that the chancre can occasionally be overlooked but it is far more often missed when syphilis occurs in other locations.  I doubt that you would have missed a lesion and predict that your syphilis test will be negative.  EWH

[Platformer]

Dr Hook,

Thanks for your response. I am now awaiting my Syphilis test results. Before getting the test I went to see my GP about the sores on my arms and he thinks they are staph and prescribed a week of Keflex, so I had been taking Keflex for almost a week before taking the test (the sores seem to be unaffected). Will this affect the test result or potentially give a false negative?

Also, a question about initial chancre. Often I hear that these can go unnoticed. Can the initial chancre be faint and almost unnoticeable when presenting on the penis?

Thanks

[Edward W Hook, MD]

The likelihood that you got syphilis from the exposure you describe is most unlikely.  You were protected and condoms prevent syphilis transmission.  In addition, the lesion you describe really does not sound like a primary syphilis lesion.  Thus, form the outset, I would predict with confidence that your syphilis blood test will be negative.

But what if it was?  While I think this is unlikely, the fact is that a rash of secondary syphilis can take on just about any appearance, form a rash only involving the hands and soles of the feet or a diffuse rash all over the entire body.  There are many exceptions to a "classical" rash of secondary syphilis..

Finally, with regard to the duration that a rash can persist for several months. Six months would be really unusual however.  It is more likely that your rash is due to something other than syphilis.  

Bottom line, your chances of having syphilis are close to zero. No harm in getting a test however.  EWH