Syphilis Treatment and Skin Reactions: A Patient's Guide

Q: Syphilis Treatment and Skin Reactions: A Patient's Guide

Hello： <br>For reference from the Centers for Disease Control, the treatment for syphilis is as follows：<br>1. <br>Primary, secondary, or early latent syphilis—Benzathine penicillin G, 2.4 million units intramuscularly (IM) as a single injection is recommended; this is most suita

Syphilis Issues

Due to a penile ulcer, I visited the clinic on May 24th, and the doctor diagnosed it as a sexually transmitted infection that requires treatment.
I was prescribed 60 mg of Cetrizine & Fexofenadine film-coated tablets, "Oxycodone" pain relief tablets, and "Xinghui" Clotrimazole cream 1 mg/g.
Today, May 27th, I have been taking the medications and applying the cream as directed, but I have noticed similar vesicular eruptions between my pinky and ring fingers, as well as on my arm, along with a few small pimple-like lesions on my body.
I would like to know if this is normal.
Additionally, can Dr.
Du confirm if the medications prescribed can treat syphilis? How long will the treatment take?

Lin, 20~29 year old female. Ask Date: 2023/05/27

Dr. Du Shixi reply Urology

Hello:
For reference from the Centers for Disease Control, the treatment for syphilis is as follows:
1.
Primary, secondary, or early latent syphilis—Benzathine penicillin G, 2.4 million units intramuscularly (IM) as a single injection is recommended; this is most suitable for patients who cannot receive daily injections or have poor adherence.
2.
For patients allergic to penicillin—any of the following alternatives may be used:
- Doxycycline, 100 mg orally twice daily for 14 days
- Tetracycline, 500 mg orally every 6 hours for 14 days
3.
Late syphilis—Benzathine penicillin G, 2.4 million units IM once a week for 3 weeks.
4.
Neurosyphilis—any of the following methods:
- Crystalline penicillin G, 2 to 4 million units intravenously (IV) every 4 hours for 10 to 14 days
- Crystalline penicillin G, 2 to 4 million units IM plus probenecid 500 mg orally every 4 hours for 10 to 14 days
*For patients with late syphilis, consideration should be given to performing cerebrospinal fluid (CSF) analysis, especially for those with a history of treatment failure, co-infection with HIV, or neurological symptoms.
*Patients with neurosyphilis should have serological testing for syphilis and CSF analysis every 6 months until the cell count in the CSF returns to normal.
*Pregnant women with syphilis who are confirmed to be allergic to penicillin through skin testing should ideally undergo penicillin desensitization therapy, followed by appropriate dosing for formal treatment; erythromycin has been shown to have an excessively high failure rate and is no longer recommended.
*For primary, secondary, or early latent syphilis patients who are also co-infected with HIV, the treatment dosage should be equivalent to that for late syphilis.

Reply Date: 2023/05/27

More Info

When it comes to understanding syphilis treatment and the associated skin reactions, it's essential to have a comprehensive grasp of the condition, its treatment options, and potential side effects. Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It can present in various stages, and treatment typically involves antibiotics, most commonly penicillin.
In your case, it seems you have been prescribed a combination of medications, including "喜寧" (likely referring to azithromycin), "飛敏耐膜衣錠" (which may be a form of doxycycline), and topical treatments like "杏輝"紫菌素乳膏 (which is likely a topical antibiotic). While azithromycin and doxycycline can be effective against syphilis, penicillin remains the gold standard for treatment, especially in primary and secondary stages of the disease.
Regarding the skin reactions you are experiencing, such as the appearance of small bumps or vesicles resembling sweat dermatitis, it is not uncommon for patients undergoing treatment for syphilis or other infections to experience skin reactions. These can be due to several factors:
1. Allergic Reactions: Some individuals may develop an allergic reaction to medications, which can manifest as rashes, hives, or other skin irritations. If the bumps are itchy or spreading, it may be worth discussing with your healthcare provider.

2. Drug Reactions: Certain medications can cause skin reactions as a side effect. For instance, doxycycline is known to cause photosensitivity, which can lead to rashes or skin irritation when exposed to sunlight.

3. Coincidental Skin Conditions: It's also possible that the appearance of these bumps is unrelated to your treatment and could be due to another skin condition, such as eczema or contact dermatitis.

4. Herxheimer Reaction: In some cases, patients undergoing treatment for syphilis may experience a Herxheimer reaction, which is a temporary worsening of symptoms due to the release of toxins from dying bacteria. This can sometimes include skin reactions.

As for the duration of treatment, it typically depends on the stage of syphilis. For early syphilis, a single dose of benzathine penicillin G is often sufficient. For late latent syphilis or tertiary syphilis, longer courses may be necessary. Your healthcare provider will be able to give you the most accurate timeline based on your specific situation.

In conclusion, while some skin reactions can be normal during treatment, it is crucial to monitor your symptoms closely. If the bumps worsen, become painful, or are accompanied by other symptoms such as fever or swelling, you should contact your healthcare provider promptly. They may recommend an evaluation to determine if the skin reactions are related to the medications or if another underlying condition needs to be addressed. Always follow up with your doctor regarding any concerns about your treatment or side effects, as they can provide personalized advice based on your medical history and current condition.

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