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Is Syphilitic Macule or Papule Contagious
A couple of weeks ago two small red spots appeared on my penis just behind the glans. They were flat with the skin surface. Both my dermatologist and my primary care physician, based on appearance, did not think they were syphilis. (Herpes was ruled out, too). I was treated presumptively a week later with the standard 2.4 Million Units of Bicillen, still awaiting the lab RPR report. (My guess is that this will be negative as I think there may not have been enough time for antibodies to develop). The lesions have not cleared yet, remain red in color but seem to be fading a bit, and perhaps have a slight rise but nearly still flat with the skin surface. My guess is that the lesions are in fact an early response to infection with syphilis, having had several unprotected insertive anal sex with some relatively high risk male partners over the past two months. After I saw the red spots I did have oral and anal insertive intercourse with some other male partners BEFORE the Bicillin shot. My worry is that I may potentially have exposed and possibly infected them with syphilis. Since the lesion has never advanced to a full blown chancre with a breakdown in the epidermis and the secretions containing bacteria, I am hoping that I was not contagious/infectious. So my main question is this: Is a syphilitic macule or papule contagious?
MEDICAL PROFESSIONAL
Your interest in protecting your sex partners is laudatory -- I wish everyone with syphilis (or the possibility of it) had the same sense of responsibility. However, none of this information changes my opinon or advice. This isn't syphilis.
"...if it's not primary or secondary syphilis, nor herpes... What might it be??" The large majority of genital skin rashes and other skin problems are not STDs, and whole treatises have been written on genital dermatology. Most lesions turn out to be genital manifestations of garden variety skin conditions, everything from psoriasis to lichen planus to scabies and others. Beyond that, I can't speculate and won't try. If the lesions persist, as I suspect they will, you'll need to return to your primary care doc or the dermatologist and take it from there.
"If this is a primary lesion, that did not have the opportunity to erupt into a fully abraded chancre sore before treatment..." Incipient chancres generally ulcerate within 2-3 days of onset. You make a wise point about patients not noticing subtle lesions for prolonged periods. However, this has not been observed in either animals or humans (in distant past inoculation experiments that today would be ethically impossible).
Your negative RPR further confirms you don't have syphilis. Even primary syphilis usually gives positive RPR results by the time a chancre has been present a week or more. As you suggest, you could have another RPR in a few weeks, but I see no need. If you do it, I'm confident it will remain negative.
So accept the analysis as good news, that you don't have syphilis and don't need to go through the potential embarassment of contacting partners. Follow up with your doctor(s) for the penile lesions.
"...if it's not primary or secondary syphilis, nor herpes... What might it be??" The large majority of genital skin rashes and other skin problems are not STDs, and whole treatises have been written on genital dermatology. Most lesions turn out to be genital manifestations of garden variety skin conditions, everything from psoriasis to lichen planus to scabies and others. Beyond that, I can't speculate and won't try. If the lesions persist, as I suspect they will, you'll need to return to your primary care doc or the dermatologist and take it from there.
"If this is a primary lesion, that did not have the opportunity to erupt into a fully abraded chancre sore before treatment..." Incipient chancres generally ulcerate within 2-3 days of onset. You make a wise point about patients not noticing subtle lesions for prolonged periods. However, this has not been observed in either animals or humans (in distant past inoculation experiments that today would be ethically impossible).
Your negative RPR further confirms you don't have syphilis. Even primary syphilis usually gives positive RPR results by the time a chancre has been present a week or more. As you suggest, you could have another RPR in a few weeks, but I see no need. If you do it, I'm confident it will remain negative.
So accept the analysis as good news, that you don't have syphilis and don't need to go through the potential embarassment of contacting partners. Follow up with your doctor(s) for the penile lesions.
Thanks for the quick response. The lesions: One round 4mm diameter; one oblong 3mm x 1 cm; next to each other separated by 3 mm--pinkish /red; located top side of penile shaft directly behind glans.
Regarding macules and papules, a number of online references (Wikepedia & others) say that the classic emergence of a chancre if from macule to papule to ulcerated lesion. Is it possible that in clinical practice, patients generally do not notice the minor papule until it becomes a full blown eroded chancre, hence, the lack of clinical observation of this earlier stage in the doctor's office, and a possible explanation for my pcp and derm to question the flat undeveloped lesion as syphilis? Doesn't a primary lesion always precede secondary syphilis lesions? I don't think I would have missed seeing a primary lesion.
Why would a reactive RPR now suggest secondary syphilis? Could it not be a reaction to a primary infection? I have not seen any other lesions on my genitals or oral cavity or anus/rectum for the past four years. I would not expect any hidden anal/rectal chancres, as I am never receptive in anal intercourse, and do not receive anilinctus. I have no rashes on my body. I did have a negative RPR on July 11, 2013, on my last quarterly screening. All of my RPR's in the last four years have been non-reactive.
First noticed these two lesions August 19th (2 weeks ago), got standard Bicillin shot August 27th (1 week ago). Lesions seem to fading out slowly.
I did read, again online, that it can take several weeks for a lesion to heal, whether or not it is treated.
So the mystery is, if it's not primary or secondary syphilis, nor herpes (my labs came back negative for HSV2; have always tested positive for HSV1).
What might it be??
If this is a primary lesion, that did not have the opportunity to erupt into a fully abraded chancre sore before treatment, but has essentially remained a macule, then, can you reaffirm, that I have not been infectious to my sex partners?? A primary macule/papule lesion only becomes contagious when it becomes an open sore--correct?? In secondary syphilis, is a flat macule type lesion (no secretions/eruptions) contagious?
Just now received RPR results on phone from doctor's office: Non-Reactive. Does this suggest lesion is primary syphilis, and that there has been insufficient time since infection to develop antibodies for the RPR to pick up? Should I do another RPR in a month or two??
My primary concern now is the possibility of having infected others. Based on my circumstances outlined here, do you think the chance of my having infected my sexual partners of the past two months, is virtually zero?? Do I need to contact anybody??
Thanks so much for your counsel!
Regarding macules and papules, a number of online references (Wikepedia & others) say that the classic emergence of a chancre if from macule to papule to ulcerated lesion. Is it possible that in clinical practice, patients generally do not notice the minor papule until it becomes a full blown eroded chancre, hence, the lack of clinical observation of this earlier stage in the doctor's office, and a possible explanation for my pcp and derm to question the flat undeveloped lesion as syphilis? Doesn't a primary lesion always precede secondary syphilis lesions? I don't think I would have missed seeing a primary lesion.
Why would a reactive RPR now suggest secondary syphilis? Could it not be a reaction to a primary infection? I have not seen any other lesions on my genitals or oral cavity or anus/rectum for the past four years. I would not expect any hidden anal/rectal chancres, as I am never receptive in anal intercourse, and do not receive anilinctus. I have no rashes on my body. I did have a negative RPR on July 11, 2013, on my last quarterly screening. All of my RPR's in the last four years have been non-reactive.
First noticed these two lesions August 19th (2 weeks ago), got standard Bicillin shot August 27th (1 week ago). Lesions seem to fading out slowly.
I did read, again online, that it can take several weeks for a lesion to heal, whether or not it is treated.
So the mystery is, if it's not primary or secondary syphilis, nor herpes (my labs came back negative for HSV2; have always tested positive for HSV1).
What might it be??
If this is a primary lesion, that did not have the opportunity to erupt into a fully abraded chancre sore before treatment, but has essentially remained a macule, then, can you reaffirm, that I have not been infectious to my sex partners?? A primary macule/papule lesion only becomes contagious when it becomes an open sore--correct?? In secondary syphilis, is a flat macule type lesion (no secretions/eruptions) contagious?
Just now received RPR results on phone from doctor's office: Non-Reactive. Does this suggest lesion is primary syphilis, and that there has been insufficient time since infection to develop antibodies for the RPR to pick up? Should I do another RPR in a month or two??
My primary concern now is the possibility of having infected others. Based on my circumstances outlined here, do you think the chance of my having infected my sexual partners of the past two months, is virtually zero?? Do I need to contact anybody??
Thanks so much for your counsel!
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Based on the information provided, it is unlikely the penile spots in fact were syphilis. Can you say more about the decision to treat you for presumptive syphilis, given that both your primary care doctor and the dermatologist thought syphilis unlikely? Did they think it was sufficiently likely to warrant treatment, or was that decision influenced by your own concern and perhaps request for treatment?
Papular lesions of this sort, if caused by syphilis, would most likely be due to secondary syphilis -- i.e. syphilis of at least several weeks duration -- in which case your RPR (and a confirmatory test) will be positive. It is theoretically possible that they were early primary lesions that, if untreated, would have ulcerated in a day or two, to become typical chancres. But such presentations are rare: in my 30+ years working in a busy urban STD clinic, I never once saw primary syphilis that presented in this way.
The lesions' persistence following penicillin also argues strongly against syphilis. Whether primary or secondary, if syphilis they would be expected to clear up within a few days of treatment.
In response to yoru closing question, secondary syphilis is always highly infectious; primary syphilis is not, before the chancre ulcerates.
For now, I would hold off on informing any sex partners. If the RPR is reactive, suggesting secondary syphilis, then they will definitely have to be informed -- as well as any other sex partners in the past few months. In that case, my advice would be for you (or your doctor) to report your case to the local health department, then follow the HD advice (and perhaps their assistance) in informing partners.
I hope this has been helpful. I'll be interested to learn the blood test results.
Regards-- HHH, MD
Based on the information provided, it is unlikely the penile spots in fact were syphilis. Can you say more about the decision to treat you for presumptive syphilis, given that both your primary care doctor and the dermatologist thought syphilis unlikely? Did they think it was sufficiently likely to warrant treatment, or was that decision influenced by your own concern and perhaps request for treatment?
Papular lesions of this sort, if caused by syphilis, would most likely be due to secondary syphilis -- i.e. syphilis of at least several weeks duration -- in which case your RPR (and a confirmatory test) will be positive. It is theoretically possible that they were early primary lesions that, if untreated, would have ulcerated in a day or two, to become typical chancres. But such presentations are rare: in my 30+ years working in a busy urban STD clinic, I never once saw primary syphilis that presented in this way.
The lesions' persistence following penicillin also argues strongly against syphilis. Whether primary or secondary, if syphilis they would be expected to clear up within a few days of treatment.
In response to yoru closing question, secondary syphilis is always highly infectious; primary syphilis is not, before the chancre ulcerates.
For now, I would hold off on informing any sex partners. If the RPR is reactive, suggesting secondary syphilis, then they will definitely have to be informed -- as well as any other sex partners in the past few months. In that case, my advice would be for you (or your doctor) to report your case to the local health department, then follow the HD advice (and perhaps their assistance) in informing partners.
I hope this has been helpful. I'll be interested to learn the blood test results.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
