[Question #4949] #4033 #4069 follow up - syphilis

24 months ago
Dear Dr Hook / Handsfield,
With regard to the event mentioned in my two posts (please ignore the latest one) i would like to ask a question:
Just for peace of mind had a last ab/ag test at 6 months and completely ruled out hiv. However, in light of a few new health issues, i was wondering if a testing for syphilis is needed.

Around  3 months after the event, i started developing a skin rash, looks like acne, on both sides of my trunk and the back of my arms. Literally hundreds of them and now getting them on my forehead too. Some are colourless some are dark reddish color bumps. Like i said looks like acne. Around the same time, i started seeing red rashes on my penis. Had them a few weeks. They cleared after i was prescribed an anti fungal cream.
7 months after the exposure and 4 months after they first appeared, i still have the 'acne' tho.

For four weeks now, i have had a headache that wont go away. Not intermittent, always there. painkillers seem to do little good. On average pain is 3 out of 10,  when it gets bad, perhaps a 4.5.

Last 2 months, i have had a different kind of rash on my head. Pops in different places, it is painful to the touch but they appear only under the hair so i can feel the bump but cant see them.

Also noticed a dark purple bump on the head of my penis. Been there for 4 months now. It doesnt look like the canker sore photos I've seen. Not round. Half a cm in length. No pain.  If it appeared after the exposure i would say it appeared around 3 months after it.

An intermittent pain under the jaws and groin area. Made me think lymph nodes maybe. Started around 5 month after exposure lasted maybe 2 months.

24 months ago
Apologies for lenghthy post. Please take this one as my first follow up.

Do any of these suggest syphilis? Do you think i should get tested. And  more importantly, the biggest confusion for me is if i get the test, which one should i get 7.5 months after the exposure?

Thank you very much for your assistance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome back yet again.

On quick scan of your two questions 5 and 6 months ago, you said you were treated with doxycycline for a week. That would have treated and cured incipient syphilis if you had been exposed. So syphilis is impossible as a cause of your current symptoms. Some are potentially consistent with secondary syphilis, but the overall pattern does not suggest that diagnosis.

That said, syphilis testing usually is automatic after any high risk sexual exposure. Certainly it is almost always done in people tested for HIV. So you might double check with your doctor. If you are not 100% certain you were tested and negative at that time, you could do it now just to follow standard procedures. But I repeat that if you have not been reexposed, it is impossible you now have active syphilis, because of the doxycycline.

If you decide to be tested, the particular test doesn't matter. Either of the standard screening tests -- either RPR or an ELISA (IgG or IgG/IgM type) are equally valid this long after exposure or in persons with symptoms. Whether or not you are tested, if your symptoms continue and/or you remain concerned about them, see a doctor. But no worries about syphilis or other STDs.

24 months ago
Thank you Dr. Handsfield.

Just for the peace of mind, i had a vdrl for syphilis today. As you said, the result was negative. Also booked an appointment with a neurologist for the consistent headache, but closing the book on std's for good now.

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Glad it was negative and happy you're going to be able to move on. Thanks for the thanks.---