[Question #13809] Syphilis Rash or Shingles?

11 days ago

Hi doctor, I hate being back this soon. I had an encounter with a female masseuse slightly below 2 months back. She gave me a massage while not wearing anything. Her vagina did come into contact with my leg, my back and at the end, I fingered her for a bit. There was no contact with my penis, no sex and no oral done.

On the recent Saturday, left mid-back started feeling sensitive. Sensitive to light touch only, no pain with firm pressire. On Monday, pain became more unbearable while walking. More lethargic. No rashes yet. Stuffy nose. Visited a doctor and he said it's highly likely shingles from the symptoms.

Some rashes started to develop Monday night and I went to another doctor Tuesday morning. He saw the rash and he also said it's highly likely shingles and from the looks of it, it's a natural progression.

Problem is that the rashes do not look like typical shingles. The rash has started going to the side but I'm not feeling the nerve pain anymore and the itch is bearable. Please help..very anxious that this might not be shingles and it's syphilis instead.

H. Hunter Handsfield, MD

11 days ago

Whatever the cause of the rash, it has nothing to do with the sexual exposure on your mind, or any other sexual event. It doesn't sound at all like syphilis, and by your description you could not have acquired syphils or another STI. With two doctors agreeing it's probably herpes zoster (shingles), that makes the most sense. The rash of shingles can have a highly variable appearance, and your self assessment is obviously less reliable than those of two experienced physicians. I would encourage you to reconnect with one or both doctors -- or if you remain skeptical, see a dermatologist. If indeed it is likely to be herpes zoster, you should be taking high dose valacyclovir or other other anti-herpes drug, and perhaps a corticosteroid like prednisone.

As you likely know, herpes zoster is not acquired by contact with infected persons. It results from reactivation of the varicella zoster virus, which 90% of all adults carry for life following childhood chickenpox.

This forum is limited to STI/HIV issues so I will have no further comments about it until and unless you provide more evidence that somehow an STI is responsible. (Since you're worried about syphilis, you could have a syphilis blood test. If you do so, it will be negative.)

HHH, MD

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H. Hunter Handsfield, MD

11 days ago

There was a typo in my reply, now corrected. I mistakenly wrote "The rash of syphilis can have a highly variable appearance...", now corrected to shingles. Sorry if there was any transient confusion or uncertainty.

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10 days ago

Thank you for the reply, doctor! Just for my own understanding and to clear my head, why does my encounter not count as a risk? How do people usually get syphilis? Sources online make it seem like it is extremely easy to catch syphilis.

H. Hunter Handsfield, MD

10 days ago

"why does my encounter not count as a risk?" Because you had a superficial encounter without penile penetration or even genital-genital contact.

"How do people usually get syphilis?" Intercourse, not by fleeting brief contact.

"Sources online make it seem like it is extremely easy to catch syphilis." Depends on the sources you select. You won't find such statements from professional, knowledgeable sources. For sure stay away from sites operated and populated primarily by people with or fearful of a particular health problem -- like Reddit, for example. Stick with professionally run sources (like health departments, academic institutions, etc) or professionally moderated ones, like ours.

And syphilis cannot cause a body rash less than 2 months after exposure.

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