Persistent Rash After Penicillin Treatment for Secondary Syphilis: What to Know

In stage two syphilis, after administering penicillin, there are still rashes present?

Hello, doctor.
Earlier this year, I was diagnosed with secondary syphilis due to a widespread rash.
I received an injection of 2.4 million units of penicillin.
After a week, I returned for a follow-up, and the doctor noted that the rash had not improved, so I received another injection of 2.4 million units and was advised to return in three months.
Now, two weeks have passed, and while the old rash has faded, new rashes are still appearing.
Does this indicate that the treatment was ineffective? I am very worried...
Thank you for your response, doctor.

Jason, 30~39 year old female. Ask Date: 2023/01/25

Dr. Wu Yuxin reply Dermatology

It is recommended to cooperate with your attending physician and to directly consult them with any questions you may have.

Reply Date: 2023/01/25

More Info

When dealing with secondary syphilis, it is important to understand that the treatment and follow-up process can be complex. Your concern about the persistent rash after receiving penicillin treatment is valid and warrants a detailed explanation.

Firstly, secondary syphilis is characterized by a variety of systemic symptoms, including rashes, mucous membrane lesions, and lymphadenopathy. The rash can appear in different forms, often resembling spots or lesions on the skin, and it can be quite distressing for patients. The treatment of choice for secondary syphilis is Benzathine penicillin G (Bicillin L.A), which is typically administered as a single intramuscular injection. However, in cases of more severe symptoms or if the patient has a higher titer of syphilis, additional doses may be warranted.

In your case, you received two doses of 2.4 million units of Benzathine penicillin G, which is consistent with the treatment guidelines for secondary syphilis. It is important to note that while the penicillin is effective in treating the infection, the resolution of symptoms, such as rashes, may take time. The presence of new rashes after treatment does not necessarily indicate treatment failure. Instead, it could be a part of the natural course of the disease or a reaction to the treatment itself.

The immune response to syphilis can be quite dynamic. After initiating treatment, some patients may experience a Jarisch-Herxheimer reaction, which is a temporary exacerbation of symptoms due to the rapid death of the bacteria. This reaction can lead to an increase in inflammation and may cause new rashes to appear. It is also possible that the rashes you are experiencing are residual effects of the infection rather than new infections.

Follow-up testing is crucial in determining the effectiveness of the treatment. The standard practice is to re-evaluate serological tests, such as the RPR (Rapid Plasma Reagin) or the TPHA (Treponema Pallidum Hemagglutination Assay), at 6 and 12 months after treatment. A decrease in titers over time would indicate successful treatment, while stable or increasing titers may suggest treatment failure or reinfection.

If you notice that the rashes are not improving or if you develop additional symptoms such as fever, malaise, or significant changes in your health status, it is essential to return to your healthcare provider for further evaluation. They may consider additional diagnostic tests or alternative treatments based on your clinical presentation.

In summary, while the presence of new rashes after treatment can be concerning, it does not automatically indicate treatment failure. It is essential to continue monitoring your symptoms and follow up with your healthcare provider as recommended. They will guide you through the necessary steps to ensure that your treatment is effective and that any persistent symptoms are appropriately addressed. Remember, patience is key in the recovery process from syphilis, and regular follow-up is critical to ensure your health and well-being.

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You should consult your attending physician about this issue, as they are the most familiar with your condition.