I was in a great mood last weekend because of a syphilis case I managed on Friday.

Medicine is full of thrills. By thrill I mean a cause of sudden intense sensation; excitement. It's not necessarily positive.

There's the thrill of an unusual presentation of a disease, something you've only seen in textbook photos. There's the thrill of arriving at an uncommon diagnosis, of having a diagnosis confirmed, and of performing a procedure well.

Thrills involving patient recovery are clearly good, like seeing a patient's CD4 (immune cell) count soar from 40 to 370 after six weeks of antiretrovirals.

And some thrills weigh heavy, like a pancreatic mass on CT or grossly abnormal labs that point to a particular syndrome.

Syphilis has several stages, and the case I saw last week was likely an unusual presentation of the second stage. That, combined with making the diagnosis and initiating treatment, made for a very satisfying afternoon.