Generalized pruritus is a common complaint in primary care, and scabies is often presumed due to its prevalence and characteristic lesion pattern. However, persistent symptoms after appropriate treatment should prompt clinicians to broaden the differential diagnosis, including sexually transmitted infections (STIs) that may mimic or coexist with dermatologic conditions.A 35-year-old male presented with generalized itching shortly after staying away from his usual household. Given the lesion distribution and epidemiological context, scabies was diagnosed and standard therapy initiated. Two weeks later, he returned with ongoing pruritus despite correct treatment. During reevaluation, a more comprehensive history was obtained that extended beyond accommodation changes to include sexual risk behaviors. The patient then disclosed a suspicious sexual encounter during his time away—information not initially provided. Targeted questioning about genital lesions followed, and a full STI panel was ordered, including syphilis serology, HIV, hepatitis B/C markers, and urine PCR for chlamydia and gonorrhea. This shift redirected clinical thinking from presumed treatment-resistant scabies toward possible STI-related dermatologic manifestations. A key limitation was reliance on a single epidemiological trigger at the first visit, without integrating sexual history early. Nevertheless, the measurable outcome was identification of a high-risk exposure that significantly influenced diagnostic considerations.This case highlights how a seemingly straightforward scabies diagnosis may mask STIs, an issue underrepresented in primary care reports. It demonstrates how delayed sexual history-taking can prolong symptoms and obscure the true cause.Structured, nonjudgmental sexual history-taking should be part of the initial assessment of persistent pruritus, particularly in young and middle-aged adults. A systematic approach that considers sexual exposures alongside accommodation history can prevent diagnostic delays.The case reinforces the importance of maintaining a broad differential diagnosis in persistent pruritus and avoiding premature closure—especially when treatment fails. Literature similarly notes that scabies-like symptoms may coexist with, mimic, or distract from STI-related cutaneous manifestations. Persistent itching following appropriate scabies treatment should trigger reconsideration of alternative or comorbid causes.Incorporating sexual history and STI screening into the evaluation of unresolved itching allows earlier identification of alternative diagnoses and improves patient outcomes in primary care.