[Question #12842] Worried about Syphilis - I have a rash

4 months ago

Doctors,

I am worried that I have contracted Syphilis almost 3 years ago and now I am getting some weird rash on my body that looks to be Pityasis Rosea, Psoriasis, or some kind of Dermatitis, but from a Dermatologist, there is a low chance that it is Syphilis.

Almost 3 years ago I had a sexual encounter with a woman, who stated she was clean. We had protected vaginal sex, and my condom slipped off during the last 15 seconds. That was my last encounter with a woman, and for some reason, I never got tested. But on that note, I never had any obvious symptom of burning urination or weird blisters or anything that I could notice. Almost a month ago, I developed a couple of rash patches, one on my arm and one bigger one on my back. After that, more started to show up across my torso up and down both sides, up through my armpits and my upper arm and across my waistline.

Worried I tested for Syphilis and was non=reactive via RPR, Rfx Qn RPR/Confirm TP with Labcorp. That was 3 weeks back when the rash presented itself. My meeting with the dermatologist, he took a skin biopsy and is testing it for weird stuff and other common rashes. Stressed I just took another RPR test today and I am awaiting results. How worried should I be?

H. Hunter Handsfield, MD

4 months ago

Welcome back. I reviewed your two threads 2 ½ years ago, which apparently concerned the same sexual exposure. I'm confused by your statement you weren't tested; previously you told us of your negative STI/HIV test panel beingn negative at 5 weeks, and that undoubtedly included syphilis. That result was 99% proof you weren't infected. And you had a near-zero-risk exposure anyway.

It is true that some skin rashes can mimic the rash of secondary syphilis. However, it is clear your dermatologist understands the differences and I see no reason not to believe his evaluation that your rash isn't syphilis. And anyway the negative test results you describe prove you don't have it. There was no need for the other RPR test taken today; it also will be negative."

"How worried should I be?" Zero. it is not possible you have syphilis.

HHH, MD

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4 months ago

Dr. Handsfield,

Thank you for your reply. This is my first time posting to this board in maybe 10 years. Someone may have had a similar username. After this sexual experience I did not test. It was essentially a one night stand. Regardless, I did test with a non-reactive result via RPR 3 weeks ago with this rash appearing. My only real follow up question is if this was syphilis, would an RPR test be sensitive enough to detect it even after say 2.5 to 3 years after potential exposure? I should get my second test result via RPR today. Side note, thanks for answering my questions. You guys are awesome here.

4 months ago

Just a quick update, my RPR test for Syphilis results from a blood draw yesterday were non-reactive. So that is two non-reactive RPR tests for Syphilis since this weird rash presented itself. I am just waiting for the skin biopsy results from dermatology to come back. A bit of a confession, when the doc looked at the rash he did ask about sexual activity. Seeing my last contact was over 2 years ago I told him that there wasn’t anything. So I don’t know if I misled him. On that note, he did say he was going to look for any “mimicking” markers in the biopsy to rule out the more worrying things. But I would hope with two non-reactive tests my mind should be at ease. Just wanted to give an update.

H. Hunter Handsfield, MD

4 months ago

Sorry for the misunderstanding: you're exactly right, someone else has the same username and I didn't notice that other information in your account doesn't fit with the previous user. My apologies!

If you had acquired syphilis, you would have had an obvious chancre (open sore) of your penis within a couple weeks of the exposure; and HIV is rare in female sex workers in the US.

Your negative RPR is 100% proof you do not now have active syphilis and that it is not a possible reason for your current skin rash. You really didn't need the new RPR and for sure it will also be negative.

Thanks for the thanks; apologies again for the mixup about previous threads.

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4 months ago

Thanks again, Doctor. The second RPR was indeed non-reactive. Will see what the skin biopsy results are. Still waiting on those. You guys help put peeps at ease because searching the internet makes my mind run in circles.

My best to you and all the Docs that help us anxious folks!

H. Hunter Handsfield, MD

4 months ago

The skin biopsy will make no difference in regard to syphilis, since it is already certain you do not have it. If your dermatologist has recommended biopsy for diagnosis of other conditions, that's fine. But it would be a waste of money, time, and perhaps emotional energy to do it to judge whether syphilis is the cause.

Thanks for the thanks. That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.

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