Follow Up - Syphillis Question

[happydaze]

Doctor: I posted previously in the HIV Forum and you replied.  For clarity, me scenario was the following:
In June 208 I met a guy and we fooled around (I'm a guy too).  We discussed status before we fooled around and he said he didn't have any STIs or HIV.  He is married with kids.  We did mutual unprotected oral (plus fingering and frottage which I'm not really worried about).  At the time I had a sore (maybe herpes, don't think so but not sure) on the corner of my lip (outside my mouth, not inside).  He didn't ejaculate, but I am sure there was pre-***.  Three weeks after the incident I had a major fever (around 102..5), chills and severe headache.  

I have had no chancres or other eruptions since then, but approximatey three weeks ago, I had a very itchy rash break out mostly on my chest and back, but also to a lesser extent on my arms and ankles.  The rash looks like hives and also like little pimples.  Again, very itchy.  No other symptoms at that time beyond a very itchy rash.  I went to an urgent care center and the physician there did not diagnose the rash but gave me prescriptions for doxycline and prednisone.  The doctor also told me that when he looked at my back he also saw Tinea Versicolor.  He said it was no cause for alarm and was common.  So he also prescribed me a tablet of Diflucan.  I have finished my medications, and the rash has mostly subsided, but I still see some minor breakouts in isolated areas. Again, very itchy until I put presription cortisone cream on it.

I read on another website that the rash of secondary syphilis can mimic many dermatologic conditions, such as tinea versicolor, pityriasis rosea, scabies, fixed drug eruptions, and erythema multiforme.  I am now concerned that while you indicated in the HIV forum that my episode posed no concern for HIV, there might be a cause for concern about Syphilis. Is my concern valid and should I test for syphilis?  I am really freaked out now.  Thanks again for your help.

[Edward W Hook, MD]

I have reviewed your prior interchange with Dr. Handsfield as well as a number of your 35 other posts related to this encounter.  As you have been told a number of times, this was a very low risk encounter.  that is true for syphilis as well as for HIV and other STDs.  Let's address your syphilis risk:

1.  syphilis is a very rare infection.  In the U.S. this year, there will be less than 9000 cases of primary or secondary syphilis in our population of nearly 350 million.  that makes the infection rare.
2.  you did not have a primary lesion.
3.  While the rash of syphilis is very, very variable, you are the wrong person to get it.,  you had a single, relatively low risk exposure.  

thus, could it be syphilis, yes.  Is it likely to be - emphatically no!.  I would bet a lot of money that you do not have syphilis.

So, what should you do?  You can either accept my assessment of get tested. That is what I would do - forget about it.  On the other hand, if my assurance is not sufficient, and you choose to get tested, please realize that virtually everyone who has syphilis will have a positive blood test at the time they have their rash. Thus, iwhen your test is negative, as I am sure it will be, you can be 100% assured that you do not have syphilis and forget about it.

hope this helps.  Take care.  EWH

[Edward W Hook, MD]

Your results are conclusive.  No need for further tesitntg

EWH

[happydaze]

Just an update:

I did get tests done for HIV, Syphilis, Chlamydia and Gonorrhea.  The results came back today:  all negative.  These results are conclusive as they are more than three months past the date of my exposure.  Of course, you and Dr. Handsfield were correct!  Thanks again for your help.

[happydaze]

Yes, your comments were very helpful.  Thanks for your informative reply.