I was treated for syphilis, but I keep getting rashes. What’s wrong?

Dr Flo,
I am 23 years old. First, I was diagnosed with syphilis two years ago and it was treated early. However, I get rashes every once in a while. They are not very painful, but they emit pus and a white or grey, hard substance. I also have lower back aches. Secondly, I usually ejaculate prematurely. I get an erection fast and during intercourse I ejaculate in less than five minutes. Help me.
John

Dear John,
You have raised several issues. Syphilis is a bacterial infection usually transmitted through sexual contact. When you initially get infected, you get a firm, round and painless sore at the site of infection, which heals after three to six weeks. If you get appropriate treatment at this stage, the syphilis is usually cured completely. If the infection is not treated, then you can get to the secondary stage which manifests as a rash on one or more areas in the body, which may include the palms and soles of the feet and mucous membranes. You may also get a fever, swollen lymph nodes, weight loss, headaches, muscle aches and patchy hair loss. If this is not treated appropriately, it will disappear on its own and you may go for some years without symptom, until the infection shows up again attacking different organs like your blood vessels, the heart, eyes and brain, and can even cause death.
Since you got treatment early, the syphilis infection should have cleared. Unfortunately, it is possible to get infected again if you are exposed, especially if your sexual partner was not treated or a has a new infection. The swellings you are getting may also be due to the hair follicles getting blocked by bacteria and other substances. It is also more common in overweight people. It is not contagious and it does not occur due to poor hygiene. Sometimes the swellings clear on their own, and may leave a scar. Due to the recurrence, you need to see a doctor or a dermatologist.
The back pain may be completely unrelated to the rash. The lower back supports the upper body, and helps with movements of the lower part of the body. Because it gets a lot of stress and strain, it can easily get injured. It can be mechanical pain, that is, pain in the muscles, joints or ligaments triggered by movement, physical activity, poor posture or loading. It can also be radicular pain, which is the pain that develops when a nerve is compressed or inflamed, causing pain in the back and/or in the thighs and legs. The pain may also be due to problems with the discs, arthritis, or from infections or tumours. To manage the pain, you can use medication, warm compresses, massage, lumbar support and physiotherapy. Avoid working while bending or lifting heavy things. Also, maintain good posture. If the pain persists, visit an orthopaedic specialist.
The normal male sexual response cycle involves desire, arousal, plateau, ejaculation, and resolution. The average time from beginning of intercourse to ejaculation is five minutes. If ejaculation happens sooner than you or your partner would like, it is called premature ejaculation. If it happens once in a while, then it is not a cause of concern. If it is frequent and is causing frustration, then it needs to be addressed.
It can occur due to psychological and physical factors. Psychological issues include traumatic early sexual experiences, worry about sexual performance, anxiety, depression, guilt, poor self-image or relationship problems. Physical factors include abnormal levels of hormones or brain messengers (neurotransmitters), or inflammation of the urethra or the prostate.
To manage it, any psychological issues need to be addressed, if necessary, by visiting a mental health professional. You also need to have a supportive partner. Some medication can be prescribed and topical creams that have a numbing agent.
Other ways of managing it include:
1. Avoiding sexual intercourse for some time and focusing on other forms of touch to reduce the pressure to perform.
2.  Strengthening the pelvic muscles using kegel’s exercises – tighten the muscles that you would use to stop urine flow. Contract these muscles 10 times and repeat at least three times a day.
3. Stop-start technique – during intercourse, when you feel the urge to ejaculate, stop all activity until it passes, then start again. By repeating as necessary and some practice, holding off ejaculation can become a habit.
4. Pause and squeeze technique – during intercourse, when you are about to ejaculate, have your partner squeeze the penis where the head joins the shaft for several seconds, until the urge passes, then continue.
5. Using a condom to reduce sensitivity

Dr Flo,
During a recent visit to my doctor, she insisted that I take a cholesterol test. Physicians assert that one must constantly monitor blood pressure and that hypertension and obesity can cause heart attacks. Please enlighten me on this.
ADW

Dear ADW,
A heart attack (or a coronary event) happens when there is reduced or no blood flow and reduced oxygen going to a part of the heart, causing death of the heart muscle. It usually happens over several days and causes a squeezing chest pain, shortness of breath, dizziness and nausea. Women may experience pain in the jaw, neck, back or arm. Most of the time, the heart attack occurs due to a clot in heart blood vessels that are hardened by fatty calcified deposits (atherosclerosis). Risk factors include having a close relative who had a heart attack, obesity, diabetes, high blood pressure, smoking and lack of exercise. High cholesterol levels, high blood sugar, high blood pressure, obesity and smoking can contribute to damaging of the blood vessels and the accumulation of the fatty calcified deposits that narrow the blood vessels and reduce or block blood supply to heart muscle, thus causing a heart attack.

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