[Question #3668] itchy rash

33 months ago
Dr Hook or Handsfield,

I have only a few recent exposures, all with female CSWs....one episode of unprotected cunnilingus, two receipts of unprotected fellatio, and one episode where I received protected fellatio and vaginal intercourse....the unprotected oral sex (69) was a few months ago, the unprotected fellatio about 1.5 weeks ago and the protected sex a couple weeks ago...the day of or the day after the unprotected fellatio (she just licked my shaft) I have an itchy rash, it has persisted for a week and a half, it's extremely itchy, arms, legs, feet, hands, torso, neck (not on palms or soles, only on the top of hands and feet).  it seems consistent with contact dermatitis, doesn't turn red until after I scratch and looks more like uticaria or hivey....I leave red streaks that stay after I scratch them.  there are no other symptoms.   the itch is maddening, but is controlled with oral dyphenhydramine or topical cortisone or diphenhydramine.  

question: is there any way that this could be very atypical  secondary syphilis or some other STD?   I have not had any unprotected intercourse, and these were all paid CSWs (female).  I can't figure out any other environmental exposure and wonder if i should get tested.  the itch is extremely pruritic, but there is no pattern or demarcated rash until after i scratch.

thank you in advance, you guys are lifelines to the world....
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome back to the forum (sort of:  see below).

No STD causes this sort of rash. Secondary syphilis rash doesn't appear sooner than 6 weeks and usually 3 months or more after catching the infection; and generally doesn't itch. Syphilis is not a possible cause of this problem, which probably is unrelated to the sexual exposure. Given how prominent the itching is, I suggest you get professional care for diagnosis and perhaps treatment. 

Thanks for your thanks and the "lifelines" comment. However, this is your ninth question on the forum, all of which seek reassurance after various kinds of sexual exposure. But it seems you have almost entirely safe sex (for example, oral sex is safe sex, with low risk for all STDs). Still, given your sexual lifestyle (and your email handle), I would advise routine STD testing (urine gonorrhea/chlamydia, blood tests for syphilis and HIV) once a year; and of course seek care if you get typical STD symptoms. It shouldn't be necessary to seek our reassurance every time you get concerned.

Best wishes--   HHH, MD

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33 months ago
diagnosed w scabies...2 rounds of treatment prescribed...probably from massage parlor towels... Who knows?  Possibly from work....
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Thanks for the follow-up. Scabies often doesn't cause symptoms until several weeks after exposure. It's a fair bet you caught it during one of the sexual exposures you mention above. Pretty unlikely "from work", assuming your workplace doesn't involve sex, sharing beds, clothing, etc.

Also, scabies often doesn't start to improve until a couple weeks after treatment, and can even get worse after the first treatment, so a lot of people end up being treated twice.
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33 months ago
But as far as "other" stds, I'm going to take your expertise regarding the relative (low) risk of these type of exposures (unprotected oral and protected vaginal intercourse).... I'm married and even if i weren't i don't want to catch any cooties (or worse)...thanks again doc