Secondary syphillis symptoms?

[sickofit9876]

Hello.  I had protected vaginal/oral with a female CSW a little over 6 months ago.  About a month ago, I had tingling/numbness on one side of the face around the cheek/corner of the mouth area.    I didn't notice any other symptoms and this went away after about a week.   Didn't think any more about it until a couple weeks later, there were some rumors that this CSW gave someone syphilis.   She has said these were false rumors but it has got me paranoid about the numbness/tingling.   Right after that, I noticed two red marks on the other side of my face close to my mouth under my facial hair.  The red spots were flaky (but mild - probably wouldn't have noticed them under normal circumstances) so after some research, sounds like it may have been dermatitis/beard rash but I still worry.  It has been about a week and these are starting to fade.   I also had 3 days in a row where I had headaches for a few hours each day.   Felt ok the last few days and no other symptoms.    Does this sound like anything to be concerned about?    I hear you say how rare syphilis is in females in the US.   I am in ATL by the way.  Could the rash be only a couple spots on one side and so mild or is it always symmetrical and more widespread?  And could the facial numbness mean anything?    Thanks in advance for your feedback.

[H. Hunter Handsfield, M.D.]

There is no way that neuritis of a single cranial nerve would ever be the only manifestation of syphilis.  But it's still dumb to speculate -- or to keep searching the internet in an apparent attempt to prove that your anxieties are justified -- when a clear answer is so readily available.  The last paragraph of my last reply meant what it said. The offer still stands, but I will delete anything other than your report of a syphilis blood test result.

[sickofit9876]

I am really sorry to be back.  I was reassured by my contact that she was syphilis free so I put this issue aside for a while.  However, I (stupidly) did some more research and found that cranial nerve damage is a common feature of neurosyphilis which can be a part of secondary syphilis - And a symptom of cranial nerve damage can be facial tingling.  Now I am freaking out again.  I know I just need to get tested but do you really feel like my facial tingling could not be a symptom?   Would neurosyphilis or meningitis be much more obvious with more pronounced illness?   Sorry again to be back.

[H. Hunter Handsfield, M.D.]

You correctly understand everything.  My recommendations are standard practice and, as I said, I also recommend them for reassurance.  You were sufficiently concerned to come to a forum like this and ask questions, and even noted that there is a rumor about your partner and syphilis.  Many (most?) persons with such concerns will continue to worry at least a little, no matter how reassuring the words from an expert based on probabilites and statistics.  

That will end this thread unless you want to return at a later time to post a syphilis test result.

[sickofit9876]

Sorry - actually hit send to soon.   To complete the question - do you feel a protected act is not as protective for syphillis as for some other std's OR do you always recommend testing in cases where one person was known to be infected (i.e. would you recommend testing if the rumor was gonorrhea instead?).   Just wondering if this is the standard practice.   That was the last question. Thanks again.

[sickofit9876]

Thanks for the quick response.   So to summarize, you are saying nothing in the symptoms I have had suggests syphilis and it is highly unlikely given the prevalance of the disease in this population and the (protected) acts performed.  Testing is just to be completely sure and to provide reassurance because of the rumors.    Do you feel a protected act is not as protective for syphillis as it is for some other std's?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question and for reading others similr to your own.

It is correct that heterosexually transmitted syphilis remains rare in the US (under 10,000 cases per year in the entire country) and that few sex workers are infected.  Atlanta may be on the high side in terms of heterosexual syphilis, but still it s unlikely your partner was infected.  And in any case, with condom protected sex -- both vaginal and oral -- the chance of transmission was virtually nil even if your partner was infected.  

That said, given the rumor about the sex worker and syphilis, it would be wise for you to be tested for syphilis -- as well as for reassurance.  However, in the off chance it is positive, it won't explain your symptoms, which are not typical of secondary syphilis.  The skin rash of secondary syphilis is typically body-wide; another common clue is that it causes red spots on the palms and soles (which most skin rashes do not).  It also is an unlikely cause of facial numbness.  As for other possible causes, I really can't speculate; there are many possiblities, and on this forum we don't get beyond STD issues.

The DeKalb and Fulton County STD clinics are very good and would be good options for syphilis testing, although almost any qualified health care provider could do so.  I do suggest examination and testing in person, to assess your symptoms as well as request the blood test.  They'll probably suggest HIV testing as well, as would I. HIV testing is pretty much automatic whenever syphilis testing is done, and I don't have any suspicion you have HIV.

Best wishes--   HHH, MD