Syphilis Treatment: Managing Symptoms and Concerns

Q: Syphilis Treatment: Managing Symptoms and Concerns

Hello： Syphilis can indeed present such phenomena. <br>It is correct to have a blood test three months after treatment; testing now has no reference value. <br>Additionally, regular blood tests should be conducted within two years, as some individuals may experience a resurgence

Syphilis treatment

I previously visited a doctor due to a rash all over my body (including my hands and feet), which was suspected to be secondary syphilis, with a screening result of 64+.
At that time, I also had an ulcer in my anal area that was severely swollen and inflamed.
1.
The doctor prescribed me eight tablets of azithromycin.
After a week, the swelling in my anal area decreased, but I was still experiencing blood in my stool, and the rash all over my body had not improved.
Additionally, my lymph nodes remained swollen (including those in the groin and posterior neck).
Upon returning to the infectious disease specialist, I was told it might be another skin condition or hemorrhoids and was advised to wait or consult another department.
2.
Three weeks later, the itching persisted, so I consulted a dermatologist, who diagnosed me with secondary syphilis dermatitis and prescribed doxycycline for 28 days.
My body and the rashes on my hands and feet began to improve, the blood in my stool stopped, and the lymph nodes started to shrink.
However, now that the 28-day treatment is over, I have a few questions for the doctor: 1.
There are still a few rashes left, which are not very noticeable, but they all flare up when I exercise, which is a bit concerning.
Is this normal? They are mostly concentrated in my abdomen and thighs, with none on my hands and feet.
2.
The lymph nodes have shrunk significantly, but I can still feel them.
Does this indicate that I am still infected? 3.
Recently, I have experienced low-grade fever for a day or two, along with headaches (which are not very painful, just occasional sharp pains), and I feel a bit dizzy with a sore neck.
Could this mean that the syphilis has affected my central nervous system? (Previously, the infectious disease doctor said to wait three months to retest, and now I’m worried about delays in treatment...
that’s why I’m asking here...
Thank you.) P.S.
I also tested negative for HIV at the beginning, and I have not had sexual intercourse in the past two months.

JL, 20~29 year old female. Ask Date: 2018/06/23

Dr. Du Shixi reply Urology

Hello: Syphilis can indeed present such phenomena.
It is correct to have a blood test three months after treatment; testing now has no reference value.
Additionally, regular blood tests should be conducted within two years, as some individuals may experience a resurgence in their titers and may need to start treatment again (indicating the need for ongoing blood monitoring).
If your unsafe sexual activity occurred around 100 days ago, you may consider retesting for HIV to confirm your status, as HIV can sometimes present with subtle symptoms.
If you contract syphilis, it is crucial to be particularly vigilant, as reinfection with HIV would require more than just a few days of medication for treatment.
Please pay attention to safe sexual practices.
Wishing you good health.

Reply Date: 2018/06/23

More Info

Syphilis, particularly in its secondary stage, can present a range of symptoms, including skin rashes, swollen lymph nodes, and systemic symptoms such as fever and malaise. Your experience with azithromycin and doxycycline is consistent with the treatment protocols for syphilis, as these antibiotics are effective against the Treponema pallidum bacterium that causes the infection.
1. Skin Rash and Exercise: The fact that your rash becomes more pronounced with exercise is not uncommon. Physical activity can increase blood flow and cause the skin to react, especially if there is residual inflammation or sensitivity from the syphilis infection. While it is reassuring that the rash has diminished, it is essential to monitor it. If the rash worsens or new symptoms develop, it would be prudent to consult your healthcare provider.

2. Lymph Node Swelling: The reduction in the size of your lymph nodes is a positive sign, indicating that your body is responding to the treatment. However, persistent lymphadenopathy (swollen lymph nodes) can occur even after successful treatment, as it may take time for the lymphatic system to return to normal. It does not necessarily indicate an ongoing infection, but it is crucial to follow up with your healthcare provider to ensure that there are no other underlying issues.

3. Low-grade Fever and Headaches: The low-grade fever, occasional headaches, and neck discomfort you are experiencing could be attributed to several factors, including residual effects of the infection, a reaction to the antibiotics, or even a separate viral illness. While it is understandable to be concerned about the possibility of neurosyphilis (which can occur if syphilis is left untreated), the symptoms you describe are not definitive indicators of this condition. Neurosyphilis typically presents with more severe neurological symptoms, such as changes in mental status, severe headaches, or other neurological deficits.

Given your situation, it is crucial to maintain open communication with your healthcare provider. They may recommend follow-up blood tests to monitor your syphilis titers and assess the effectiveness of the treatment. It is also essential to report any new or worsening symptoms, as this can help guide further management.

In summary, while some residual symptoms can be expected after treatment for secondary syphilis, it is vital to keep your healthcare provider informed of your condition. They can provide the best guidance on whether further evaluation or treatment is necessary. Additionally, if you have any concerns about the possibility of neurosyphilis or other complications, do not hesitate to express these concerns to your doctor. Early intervention is key in managing any potential complications effectively.

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