<s>[INST] Hello doctor, I have been having rashes on my hands, forearms, trunk, and feet for four weeks now. The rashes on my hands and feet have lesions. The rashes are not itchy, except for those with lesions. I also have a small wound (or sore) on my anus, which has been there for three weeks now. I believe this is syphilis. I have taken Loratadine for seven days, as prescribed by a doctor here. However, nothing happened. I cannot have it checked due to the quarantine in my area. Does my condition need immediate medical care? Or can I take medicine to treat this while waiting for the ECQ to be lifted? I did not have a fever or flu when this started. I would also like to add that I have been having dandruff on my beard and mustache, and an itchy scalp. There are also dry patches on the area near my chin and they are flakey. They do not flake sometimes, though. I have been applying moisturizer on my face since they started to appear. Another thing, the folded skin on my underarm and area behind my knee can sometimes have a burning sensation. I did not know what is happening. I hope you can help me with this. [/INST] Hello. Prior to the onset of rashes did you observe any lesion or wound on your penis? Or sexual encounter with someone who had such? May I ask questions about your sexual history? How many sexual partners have you had? Male or female? Are you aware of your partner's promiscuity? What do you do? Any other diseases? Is this the first time this has happened? Besides Loratadine have you tried taking any other medications? Any allergies? Based on the given health data, it is likely you may have secondary syphilis. Can you send photos of the rashes on your trunk or arms? Where did it start and how did it spread? Any throat pain or gun lesions? If you're having difficulty of breathing, fever, changes in sensorium, numbness or weakness please proceed to the ER. Otherwise, we could start treatment for now but will require laboratory results to confirm the diagnosis. Please do VDRL or RPR (whichever is available) and FTA-ABS or TPPA (whichever is available). I suggest to start Doxycycline 100 mg twice daily for 14 days (Please do lab works before starting your medication. The results may turn out negative if you have taken your dose and if it is negative we will have to stop the treatment). Regarding dandruff, I suggest to shave your beard. Use anti-dandruff shampoos. May continue the application of moisturizer on the affected area. Regarding the burning sensation, it maybe related to syphilis. Are there any rashes present? Is it often damp? Is the area reddish? Continue to take baths and maintain good proper hygiene. Please send your CBC (complete blood count) results. VDRL (venereal disease research laboratory) or RPR (rapid plasma reagin) and FTA-ABS (fluorescent treponemal antibody absorption) or TPPA (treponema palladium particle agglutination assay). Abstain from sex for now. Proper hygiene. </s>