Syphillis or Sebaceous Cyst?

[Caligirlwoes]

Hello, I have a question and feel rather helpless at the moment in seeking medical attention. I recently had unprotected sex with my boyfriend of 11 years. We have never used condoms (only the pill). He and I broke up for awhile this April, reconciling in June. I was tested in May for Gono/Clam/HPV all were negative. After my boyfriend and I got back together, he admitted to having slept with another woman while we were split. She is very promiscuous and that made me nervous. It's been almost a month since our first unprotected encounter since my negative tests. I was urinating this past Monday and felt a pain near my clitoris when I was wiping the area. I looked at it with a mirror and was unable to really see much. It just looked like a tiny bump underneath the skin..that could maybe come to the surface. Almost resembled a pimple on the face. It could be felt like a small bump, and it was somewhat painful to touch, though not incredibly. I had rather rough sex with my boyfriend a few days before discovering this and also, my period had ended right before as well. I had googled the bump looking for answers. I am now worked into a frenzy thinking it could be syphilis. While the pictures of the Chancres don't resemble very closely what I have it is hard to see it well down there and I wasn't sure they always look like sores, maybe my sore didn't come to the surface?? Anyhow, the bump is getting smaller and harder for me to even find anymore. I am concerned that this is syphilis. Also, I don't know how soon it will show up in a blood test and there really isn't a great place for them to swab on my vagina. My main concern is that if this is syphilis, we have to both be treated so we do not continue to pass it back and forth. He also has a patchy rash (he says heat rash) on his chest. Does this sound right? I am scared we have syphilis..what do you think? Any advice will be greatly appreciated. Thank you in advance.

[H. Hunter Handsfield, M.D.]

Thanks for your question.  Welcome to the forum.

Syphilis is very, very unlikely.  Syphilis is a rare problem in the US as present, including most commercial sex workers and other heterosexuals with multiple partners.  The syphilis epidemic is concentrated primarily in men who have sex with men.  So it is very unlikely your partner was exposed to syphilis.  Second, if your partner had acquired syphilis, he probably would have had a penile sore (chancre).  Third, as you were told on the community forum, a bump like you describe is not consistent with syphilis.  As you suggest yourself, a sebaceous cyst or some other non-STD explanation is much more likely.  Finally, even if were a typical chancre, it couldn't start to improve this soon.  Without treatment, chancres last for at least 2-3 weeks.

Since you are concerned, I would suggest syphilis testing.  Plenty of time has passed for your boyfriend to have a reliable blood test:  with exposure in April or May, a negative test now would prove he wasn't infected and therefore could not have infected you.  If for some reason he can't or won't be tested, you could have a blood test for syphilis yourself once 6 weeks have passed since you resumed sex with him.  (Don't worry about an immediate examination.  There is no "swab test" for syphilis, so it doesn't matter if your genital bump has cleared up.)

Whatever you do, stay mellow in the meantime.  This is a very low risk situation with regard to syphilis, and neither your nor your partner's symptoms make me at all suspicious of it.

I hope this has helped.  Best wishes--  HHH, MD

[Caligirlwoes]

Thank you so much! I appreciate your immediate response and concern for our well being. I am trying to remain as calm as possible, you have helped ease my mind. It's one of those things where I know deep down I am fine, but can't help get those images online of syphilis out of my head!! Thank you again.