1. The Case of the Missing Hair Salt Lake Valley Health Department STD Clinic

2. Background Information A 29 year old male came into the Salt Lake Valley Health department for STD testing.His main complaint was spontaneous hair loss.A 29 year old male came into the Salt Lake Valley Health department for STD testing.His main complaint was spontaneous hair loss. His other complaint was spider bites on the palms of his hands.His other complaint was spider bites on the palms of his hands.

3. Patient History Positive Chlamydia in 2003Positive Chlamydia in 2003 Last reported HIV test 2 weeks previous to this visit and was negative.Last reported HIV test 2 weeks previous to this visit and was negative. Sex with women onlySex with women only No history of IDU or trading sex for money or drugs.No history of IDU or trading sex for money or drugs.

4. History continues No known drug allergiesNo known drug allergies Medication in last two week: AfrinMedication in last two week: Afrin Engages in oral and anal sex.Engages in oral and anal sex. 3 partners in the last 3 months.3 partners in the last 3 months. 100 percent condom use.100 percent condom use. Denies any history of genital sores or rash.Denies any history of genital sores or rash.

5. Physical Exam Multiple patches of hair loss (moth-eaten appearance).Multiple patches of hair loss (moth-eaten appearance). Normal genital exam.Normal genital exam. Red macules noted on palms of hands.Red macules noted on palms of hands.

9. STD Testing Urine Gonorrhea and Chlamydia: negative.Urine Gonorrhea and Chlamydia: negative. RPR 1:128RPR 1:128 FTA reactiveFTA reactive

10. Assessment Secondary Syphilis with possible onset of palmer rashSecondary Syphilis with possible onset of palmer rash Syphilis AlopeciaSyphilis Alopecia

11. Plan Bicillin LA 2.4 m/u IMBicillin LA 2.4 m/u IM Patient education on Jarisch-Herxheimer reaction.Patient education on Jarisch-Herxheimer reaction. Return to clinic at 6 mo.,12 mo and 2 year for follow up RPR.Return to clinic at 6 mo.,12 mo and 2 year for follow up RPR. Contact management.Contact management. RTC in 3 months to repeat HIV test.RTC in 3 months to repeat HIV test.

12. Additional information The patient was interviewed for contacts and admitted to sex with men and multiple partners.The patient was interviewed for contacts and admitted to sex with men and multiple partners. Patient had one regular partner who was presumptively treated in L.A. within 24 hours, and several additional male partners in L.A. and Salt Lake. Patient referred to some “clubbing” activities. Patient self referred several male partners to our clinic.Patient had one regular partner who was presumptively treated in L.A. within 24 hours, and several additional male partners in L.A. and Salt Lake. Patient referred to some “clubbing” activities. Patient self referred several male partners to our clinic.

13. Disclaimer Copyright all clinical photos:Copyright all clinical photos: –Cammie Barrus, APRN, Salt Lake Valley Health Department, STD Clinic. Individual slides can be used for educational purposes with reference to source.Individual slides can be used for educational purposes with reference to source.