I got small bumps on the penis after oral sex. Can it be syphilis?

Question

Hi doctor,

I have five small bumps appeared on the head of my penis after I had oral sex. It has been two months now, but it is still there. I have attached the photo. Also about two weeks ago I got rash on my hands, around the feet, and legs. When I consulted a doctor he said it is probably syphilis and gave me 2,400,000 units of Penicillin G shots. However, the results of blood test came back negative for syphilis. The result is rapid plasma reagin non-reactive. I am really confused whether the rash is related to oral sex or not. Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I need a few more details to guide you. Please do tell me the complaint about the bump and rash. After how many days of exposure had you undergone RPR (rapid plasma reagin)?

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have seen the attached pictures (the attachment was removed to protect the patient's identity). Clinically, it is a case of syphilis with a lesion matching the presentation of secondary syphilis. Rapid plasma reagin (RPR) was negative because it is an antibody-based test. It usually takes six weeks to become positive after the exposure. Please undergo VDRL (venereal disease research laboratory) test, as it is diagnostic and is the only test to assess treatment response. Although you have taken the recommended treatment for secondary syphilis, I would suggest you take a tablet of Doxycycline 100 mg twice daily for 14 days and Azithromycin 500 mg for five days. As Doxycycline causes acidity, do not forget to take Pantoprazole 40 mg half an hour before the meal. I am prescribing the medication even if you have taken the recommended one for syphilis because this is called syndromic management of a sexually transmitted disease. As syphilis is frequently found in association with gonorrhea and chlamydia this approach will treat all the concurrent infections.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

Since the route of acquiring syphilis, Treponema pallidum is not through the penis, the chances of acquiring primary chancre are also less. Syphilis can also occur due to blood transfusion and in such cases, no primary chancre appears this is known as syphilis d' emblee. The bumps on the penis seem to be unrelated to STD (sexually transmitted disease). They are follicular prominences and can remain there for very long without any harm. Electrofulguration or laser can be tried for them but according to me it is not needed.

Thank you.