Syphilis chancre

[Stan__zz]

Dear Dr. EWH or HHH, I have a question about the primary lesion/syphilis chancre (ulcus durum). My really low risk was a handjob 3 weeks by a massage lady. While I know my risk is very close to zero, my feelings of guilt and worry drove me crazy. I even went back to the place and inspected her hands/fingers and found no abnormalities. My questions (No.1 is most important for me!):

1) I have only seen pictures (internet) of syphilis chancres, some of them on fingers. These lesions looked VERY obvious (big, open). Is it even possible to overlook an infectious finger lesion with careful examination?

2) Do I need to get tested?

3) Can I have sex with my wife?

4) I know this somehow beyond the scope of this forum but... from your experience, what will be sensible next steps to break this worrying cycle?

Thank you,
Stan

[Edward W Hook, MD]

The benefit of the 3 day course for syphilis prevention is unknown and has not been studied.  The recommende course of doxy for syphilis prevention is 7 days.  Three days might have some effect but how much is not known.  In your case, since there was no risk to begin with, I woul not worry.  EWH

[Stan__zz]

Dear Dr. Hook, please answer this one follow-up question. Due to a tick bite last week I was prescribed Doxycycline 200 mg for 3 days as a preventative dose for Lyme-disease. The exposure in my original question was 4 weeks ago. I have not notified symptoms. My questions:

1) Would a 3 days course of Doxy 200 mg be enough to PREVENT infection of incubating syphilis?

2) If not, how long would a course of doxy intake need to be, to prevent infection in these circumstances?

Thanks for answering, I will not post any more follow-ups.
Stan

[Edward W Hook, MD]

You are correct, it you have gotten syphilis from receipt of masturbation you will be the first such person I have communicated, ever.

Directly to your questions:
1.  No, it would be very difficult to overlook and infectious syphilis leasion.  Particularly following a direct inspection of the sort you mention.

2.  No, not unless there are lesions

3.  Yes.

4.  I hope so.  Knowledge is very helpful in situations such as these.  If not, then rather than letting the problem persist, I would suggest you discuss it with a counselor or trusted professional to get help in working through your guilt.

Hope this helps. EWH