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Q. I have small wound in anus with rashes over my body. Could this be syphilis?

Answered by
Dr. Aleph
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 17, 2020 and last reviewed on: Apr 30, 2020

Hello doctor,

I have been having rashes on my hands, forearms, trunk, and feet for four weeks now. The rashes on my hands and feet have lesions. The rashes are not itchy, except for those with lesions. I also have a small wound (or sore) on my anus, which has been there for three weeks now. I believe this is syphilis. I have taken Loratadine for seven days, as prescribed by a doctor here. However, nothing happened. I cannot have it checked due to the quarantine in my area. Does my condition need immediate medical care? Or can I take medicine to treat this while waiting for the ECQ to be lifted? I did not have a fever or flu when this started.

I would also like to add that I have been having dandruff on my beard and mustache, and an itchy scalp. There are also dry patches on the area near my chin and they are flakey. They do not flake sometimes, though. I have been applying moisturizer on my face since they started to appear.

Another thing, the folded skin on my underarm and area behind my knee can sometimes have a burning sensation. I did not know what is happening. I hope you can help me with this.

Dr. Aleph

Family Physician General Practitioner
#

Hello,

Welcome to icliniq.com.

Prior to the onset of rashes did you observe any lesion or wound on your penis? Or sexual encounter with someone who had such? May I ask questions about your sexual history? How many sexual partners have you had? Male or female? Are you aware of your partner's promiscuity? What do you do? Any other diseases? Is this the first time this has happened? Besides Loratadine have you tried taking any other medications? Any allergies?

Based on the given health data, it is likely you may have secondary syphilis. Can you send photos of the rashes on your trunk or arms? Where did it start and how did it spread? Any throat pain or gun lesions?

If you're having difficulty of breathing, fever, changes in sensorium, numbness or weakness please proceed to the ER. Otherwise, we could start treatment for now but will require laboratory results to confirm the diagnosis.

Please do VDRL or RPR (whichever is available) and FTA-ABS or TPPA (whichever is available).

I suggest to start Doxycycline 100 mg twice daily for 14 days (Please do lab works before starting your medication. The results may turn out negative if you have taken your dose and if it is negative we will have to stop the treatment).

Regarding dandruff, I suggest to shave your beard. Use anti-dandruff shampoos. May continue the application of moisturizer on the affected area.

Regarding the burning sensation, it maybe related to syphilis. Are there any rashes present? Is it often damp? Is the area reddish? Continue to take baths and maintain good proper hygiene. Please send your CBC (complete blood count) results.


Investigations to be done:

VDRL (venereal disease research laboratory) or RPR (rapid plasma reagin) and FTA-ABS (fluorescent treponemal antibody absorption) or TPPA (treponema palladium particle agglutination assay).

Preventive measures:

Abstain from sex for now. Proper hygiene.


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Thank you doctor,

I have only started being sexually active since eight months. As much as I can remember, I have hooked up with 10 people, which were all male. Penetrations were done with condoms, and only one was bare and it happened before eight months. I stopped hooking up since the rash started, which I first assumed as calluses because they were big and brown so I ignored them. This is the first time that it happened. Since I have only had hookups, I have no idea whether any of them had syphilis.

I did not observe any lesion or wound on my penis, just the one on my anus. I have only taken Loratadine since the rash started. I have no allergies or any diseases since the onset of the rashes or prior to it, probably only cough and fever which happened in February and the fever only lasted a day. I have no throat pain or gum lesion. Otherwise, my dentist would have mentioned it when I had my teeth cleaned last month.

Regarding the lab tests, I cannot do so because of the quarantine, which is being extended. If I can, can I go directly to the lab and have myself tested even without a note from a doctor? I have a tingling sensation on my palms but only when they are sweaty or wet. My underarms may be damp most of the time as I have not used deodorant since I am only staying inside the house. Will apply deo from now on and observe whether the burning sensation will still happen.

Going back to syphilis, I have read that the rashes may disappear within two to six weeks after the onset. Will they do so even without treatment? They are going for their fifth week this Saturday. I have noticed they are slightly fading on my forearms, but I cannot say the same for my hands and feet. I cannot seem to upload the images through this app. Can I send it through your email instead?

Dr. Aleph

Family Physician General Practitioner
#

Hello,

Welcome back to icliniq.com.

It does look like a typical syphilitic rash. (attachment removed to protect patient identity).You are right it will disappear eventually. The laboratories are important in order for us to ascertain the diagnosis of syphilis (and at what stage) and if it is, it will help us determine if we should start treatment and for how long.

For now, based on your symptoms and history it is most likely you have developed secondary syphilis and will need one dose of Penicillin given through intramuscular injection (this is to prevent late sequelae and resolution of said lesions). Even if it appears the disease is currently uncomplicated we want to prevent transmission and progression of the said disease.

And if it is possible, please inquire with your local health center or available clinic within the area if they can do IM injection of Pen G 2.4 million units. I will have a prescription and request written. It is also apt to contact those people you have had sexual encounters with to have themselves checked as well.


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Related Questions:
Though I had treatment for syphilis, why does my result remain reactive?
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