Does the Secondary Syphilis Rash Recur?

[teejay999]

Dear Doc:

My Sex History: age 36, straight white male. B/t ages 28 & 36, I had 20-25 partners; mostly call girls. Usually only received handjobs. But received unprotected oral from ~15 of them. Performed unprotected oral on ~4 to 5. Had vaginal sex w/ ~15 (condoms ALWAYS used). Had anal sex with 2 (condoms ALWAYS used). Also french kissed & inserted my fingers in their vaginas.  

STD Questions
1. 1st concern is HIV. Last sex encounter was Sep-09; had protected anal sex, received unprotected oral, & french kiss. I am 6 mos post any sex activity. Today(Apr 2, 2010) I had Oraquick Advanced HIV Antibody Test (took 20 mins) using drawn blood from arm. Results negative. Assuming I have other STDs, is this HIV test 100% conclusive? Can presence of ANY other STDs in my body skew this HIV test?
2. In Jan 2010, woke up in morning w/ vertigo. It resolved in 4 mins; then brutal headache for days. Vertigo & headaches relapsed for 8 wks w/ certain head movements. Also had ear ringing/stuffiness. ENT docs ran tests/CT/MRI, results normal, ruled out: Meniere's,stroke, acoustic neuroma,& balance disorders. Diagnosis: labyrinthitis w/ benign positional vertigo. Vertigo gone now; still get some ear ringing & headaches.
3. For ~8 months, I have had recurring hand rash. On palm side, appears as nonraised red dots under skin; on back of hand, finger webs,& wrist, appears as slightly raised red dots. Itching precedes outbreak. When rash present it's non-itchy. Rash lasts 4-7 days, then vanishes. Once gone, looks like nothing ever happened. Then unpredictably, hand rash re-occurs. Dermatologist stumped; is doing biopsy & testing for syphilis.
4. I have read that 2ndary syphilis rash can occur on palms. Does it ever recur (come & go)? Also read that advanced syphilis can cause vertigo & mess with ears/brain. Based on my story, can you offer your best opinion of whether or not I have syphilis? I don't recall chancre; I suppose it's conceivable I missed it b/c I'm not circumsized.

[Edward W Hook, MD]

1.  Recur means the may come back of a single occasion.  That is different from coming and going on more than one occasion.

2.  Your information is incorrect.  If you rash is due to syphilis, as I said, the blood test will be positive.

3.  Yes, this is being paranoid.  And yes, late syphilis is readily detectable using blood tests.  A spinal tap is not needed.

4.  Yes, syphilis is completely curable.  EWH

[Edward W Hook, MD]

Straight to your questions:

1.  Your results are conclusive.  Believe the test.  You do not have HIV from the low risk exposures which you describe.  If other STDs were present this would not change the reliability of your tests.
2.  This is not a question.  Your doctors have ruled out important causes of labyrinthitis.  Many cases which have no clear cut cause are thought to be due to community acquired, non-ST upper respiratory infections.
3.  A biopsy will proved direction for your dermatologist.
4.  Secondary syphilis can cause a rash on the hands an or soles, as well as a long list of other sorts of rashes.  The rash of syphilis can recur but they do not come and go.  The activities and partners you describe do not put you are high risk for syphilis which is actually a rather rare disease. If you have concerns about syphilis, a blood test will be diagnostic.  Virtually everyone with secondary syphilis has a reactive blood test.  

I hope my comments are helpful to you.  I can understand the frustration you are experiencing in sorting this out and can tell you that it sounds as though your dermatologist is doing the right things to help you sort it out.  Syphilis is most unlikely (as are other STDs) and, as I said, can be conclusively be ruled out with a blood test if you have not already had one.  Take care.  EWH

[Edward W Hook, MD]

Glad to hear of the outcome of your evaluation.  i would not be suprised at all if some of your symptoms were related to the stress you experienced.  Delighted to hear that you are feeling better. Take care.  EWH

[teejay999]

Hello, once again, Doctor:

This message contains no questions, nor does it require a reply.  If you want to delete it, please go ahead and do so.

I am writing this one last time to conclude my story, now that I know the results of my recurring hand rash.  My dermatologist did blood tests to check for EVERYTHING, and I mean EVERYTHING.  This includes a test for syphilis.  The news is excellent: EVERYTHING came back normal, and in some cases, even better than normal.  Also the test for syphilis was NEGATIVE.  My dermatologist is still stumped as to what caused my recurring hand rash, but concluded it was nothing serious at all.  He thinks it may have been an asymptomatic case of hand, foot, and mouth disease -- but he thinks this is a low likelihood, since my feet and mouth were absolutely fine and I had literally no other viral symptoms.

I can say this.  Now that I know for certain that I don't have any STDs, my recurring headaches and ear ringing have substantially stopped.  And sometimes I wonder if the ongoing stress I experienced as I had labyrinthitis and this recurring hand rash was the culprit of some of my headaches.  And I know this thread is not the place for this last comment, but to write it would make me feel better, so here it goes --- my days of sexual stupidity are OVER.  Forever.  

Thanks Doctor for your help in this thread.

Take Care.

[teejay999]

Dear Doctor:

Your comments are absolutely helpful; thank you kindly for such a quick response. If it's acceptable to you, may I ask a few follow-up questions specific to syphilis? In no way are these intended to be redundant, and in no way would I intend to watse your time. I also realize some of these questions are hypothetical. I promise to shut up after this (most likely), or VERY shortly after this.

1) In regards to potential (but unikely) secondary syphilis rash on my palms, I had thought that the terms "recur" and "coming and going" were exactly the same. Would you kindly explain (even briefly if you prefer) what it means that a secondary syphilis rash may recur, but does not come and go? (I apologize for my confusion here).

2) Assuming I contracted syphilis early on in my acts of stupidity (seeing many call girls) starting at age 28, would a RPR syphilis test done now at a clininc (at age 36, thus up to 8 years later) be able to 100% conclusively detect syphilis?  I ask because, like many, I have read that RPR tests are excellent in early and late syphilis, but possibly not middle syphilis. With respect to my possibility of having syphilis, I have no idea where I'd fall on the time spectrum.  Also, my dermatologist is doing tests on my blood to check for syphilis. I don't know what type of test he is doing, but whatever it is, in your experience/opinion, will he be able to conclusively detect it, if it is there?

3) I read about tertiary (late) syphilis, and out of paranoia, began to correlate my symptoms (such as vertigo, ear plugginess, headaches) to it.  Would you agree that I am just being paranoid and ridiculous here? Anything in my story or symptoms suggest late syphilis? Also, is late syphilis ALSO detectable with the blood tests I describe above? Or only detectable with spinal fluid?

4) Last question. Assuming a worst case that I have syphilis, is it 100% cureable? Even if I got it as early on as age 28? No matter what stage it may be in?

Thank you so much Doctor; I will shut up now.