Rigour after gonorrhea treatment in a 55-year-old man

The incidence of syphilis has increased, primarily among men who have sex with men. Syphilis presentation can be difficult to discern and might be missed, but should be suspected in persons who experience the classic Jarisch-Herxheimer reaction after treatment with β-lactam antibiotics. This case describes a 55-year-old male patient with negative test results for HIV who presented to the clinic as a contact of a recent male sexual partner who was diagnosed with gonorrhea. This case suggests that ceftriaxone and azithromycin treatment of persons with unknown infectious syphilis infections might cause a classic posttreatment syphilis reaction (rigour that spontaneously resolves). Patients should be informed to look for these Jarisch-Herxheimer reaction symptoms, and clinicians should assess for the symptoms of this reaction in patients who are at risk of syphilis