Secondary syphilis after treatment

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Hello, I am a homosexual white male, 35, hiv -, no other notable medical history. Last week I was diagnosed with secondary syphilis, presenting as sore throat, headache, and fatigue x4 weeks and spotty rash x1 week. White mucous patches were present on the tonsils last week at the clinic visit. An RPR in August was non-reactive, but LFTs at that time were elevated 5x ULN. The LFTs returned to normal within 1-2 weeks. RPR last week was reactive with titer 1:32.

I was treated 4 days ago with the standard 2.4M units Bicillin LA. I experienced a mild case of the Jarisch - Herxheimer reaction over 36 hours after treatment. The sore throat has not yet improved, the tonsils still have white mucous patches, and the rash does not appear to be improving. I'm also still getting headaches everyday, especially at night.

My question is what should I expect in terms of resolution of these other symptoms?  Weeks? Months? None of the websites discuss resolution of clinical symptoms after treatment, only serological improvement over 6 months.

Thank you

[HowardH]

I meant to say that fatigue and headache go along with either syphilis or a viral infection. If syphilis, these symptoms should be gone within a week, even within 2-3 days.

[HowardH]

Welcome to the forum.

All symptoms of secondary syphilis should clear up quite rapidly, probably within 7-10 days, and your rash will probably be gone within that time; it may be improving already. However, some of your symptoms are atypical for secondary syphilis. Sore throat is uncommon, and syphilitic mucous patches are painless. These symptoms are more suggestive of a viral infection, not syphilis, and would not be expected to respond to penicillin.

Probably you were tested for HIV, and presumably with negative result or you would have said something about it. However, without meaning to be alarming, your symptoms are consistent with primary HIV -- and since syphilis is one of the strongest predictors of new HIV infection, this has to be a consideration if you are at risk, like unprotected sex in the past 2-3 weeks or so. DNA/RNA testing for primary HIV infection might be in order. Other viral infections probably are more likely, but better safe to sorry, and something to discuss with your doctor.

Good luck and best wishes.