[Question #7117] Syphillis-Partner concern

8 months ago
Hello. Just to recap, I had two unprotected encounters with someone two years ago whom I recently remembered had, a pink bump on his genitalia. Tested in May and June of this year (first time testing for syphillis after the encounters). Initial igg/igm screening was “equivocal”, confirmatory testing via RPR and TPPA were negative. Confirmatory final result was negative. My GYN screened me afterwards with an RPR which was negative. I had no symptoms except from a weird brief non-itchy blotchy/splotchy  dark reddish-brown rash on palms of hand which went away quickly (no more than half an hour) and some weird lesions on lips which also went away quickly after a few days. I’ve felt fine. From my blood tests, it shows, and I know that, I’m negative.        However, my BF, whom I’ve been with over a year and a half, developed a dark red rash with non-itchy/non-painful spots/bumps/lesions/sores on the bottom of his feet. They started on one foot, started fading there, then began on the other foot. The lesions/bumps/spots/sores turned darker as time went on, like a reddish-brown and appeared to scab (at least the color of it). Upon fading, the rash and skin is now peeling/flacking.  You can see a scale around where a bump use to be. He’s had sole rash for awhile, at least a few months. Disappearing now. I recently suggested that when he has an upcoming appointment with his primary (via video) that he mention his foot rash so that she could maybe look into it and that he will probably have to do some bloodwork. Left it general and didn’t go into specifics as to what I thought it was (scared to). I’ll suggest he get a battery of tests, the same ones he gets at his annual physical (not sure if will).  I know he hasn’t cheated. Nothing on genitals ever seen. New questions: Can one partner have Syphillis and not the other? Can you get Syphillis if in contact with semen, blood, or vaginal fluids? Does this sound like syphillis? Concerned about his well being and my future health.
8 months ago
Oops, forgot to mention that he also had a sudden unexplained open wound on the front of his ankle below his shin which scabbed up. At first thought it was a scrape himself with something but now, not so sure. Sole rash started with non-colored bumps on and underneath then progressed.  Thanks...
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Welcome to our fourth. Thanks for your questions. I’ll be glad to comment. Let me first make a few general comments about Syphilis.  Of all STI‘s, Syphilis is a relatively rare infection. In addition the majority of Syphilis cases in the United States for the past 5–10 years have occurred and men who have sex with other men. For you to have acquired Syphilis during your encounters two years ago would be most unusual on a purely statistical basis. At the same time as I’m sure you have learned, in the second stage of infection Syphilis is well known for causing of rashes, Including hyper pigmented lesions on the palms on the soles of the hands and feet, respectively.

In addition, I should add that while the second stage of syphilis is strongly identified with the presence of a rash, the there are many, many different causes of rashes with can occur both on the genitals and/or the palms and soles of the hands or feet.
 
Now to come out on your specific situation:

It is clear that you do not have Syphilis. If you had Syphilis, without doubt your blood tests for Syphilis would be positive. The fact that you have had several negative tests absolutely rules out this possibility in your case. Further, the transient rash that you described on the palms of your hands would not be characteristic of Syphilis. When Syphilis causes a rash, the rash tends to stay in place and is apparent for weeks or even months,.

Given the history that you report and your confidence that your boyfriend has not had other partners it would be surprising for one of you to have Syphilis and not the other. While out of an abundance of caution it would be appropriate for your boyfriend to have a Syphilis blood test, I am doubtful that that is the cause of his rash. When he speaks with his doctor is Dr. should evaluate it more completely.

I hope that this information is helpful to you. If there are further questions or clarification is needed you have up to two follow-up questions which I will be happy to address. I am confident however that you do not have Syphilis. Capital EWH
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8 months ago
Thank you so much for your input. I really didn’t know the sexual habits of the person I had the unprotected encounters with. Knew him, but didn’t know if he would have had sex with men also, you never know with people. You say that hyper pigmented spots and lesions on the soles are characteristic of syphillis, and everywhere I read that’s what it is.  My Bf has had them on the soles of feet for a few months, is there anything else it could be? I feel that the  bottom of feet is a really weird place to get a rash and obviously something systemic is going on. Also, if it is Syphillis, , is it possible that he contracted it before we got together and has had it all this time? Can I catch it from his semen? The rash has only been on the soles of his feet and not on torso or generalized but I read that it can be confined to one location. He also had a sudden open wound or lesion on the front of his ankle which has scabbed up. I thought It was a scrape at first but now don’t know.  Wouldn’t I have seen something on his genitals at one point prior? Feel much better about my own symptoms cause they didn’t last long.  I don’t feel uncomfortable asking him to specifically test for syphillis but should I? I don’t want to come straight out and say that I think he has an std.  We’ve been having unprotected sex for over a year and a half. I would have to also get tested again if positive and I’m really fighting the urge to  re-test now. I’m a nervous wreck about this situation. Every time I look at the soles of his feet (rash is fading or is probably gone now) or think of them, I feel like crying,  Honestly, that initial “equivocal” screening has messed me up cause I keep feeling  that  it “picked up” something, something, or some type of activity was detected. Won’t be at ease or stop thinking of this until a syphillis test of his comes back negative, but with his classic symptom I’m doubting it will. I’m so scared for both him and I.  Hoping that once he mentions the sole rash, his doctor will automatically order a syphillis test for him. He tested like six or seven months ago and said he was “std free” but not sure if he tested specifically for syphillis. I do know that the basic panel does include it. Thanks again for your advise. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
While when one looks at the internet for information one of the first things that pops on searching rashes of this sort is Syphilis, the fact is that there are tens, if not hundreds of other non-STI dermatological conditions that cause rashes on the palms or soles.  It is always worth making sure that your BF does not have Syphilis and this can be done simply with a blood test (when the rash of Syphilis is present 99.9% of persons, at least, will have reactive blood tests) but given your history and test results, I very much doubt that his rash is Syphilis.

Syphilis is transmitted by DIRECT sexual contact with a lesion.  

Perhaps you could mention to him that you looked up rashes occurring on the soles and saw the association with Syphilis, that while you doubt that this is what he has, it would make you feel better if he would test.  EWH
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8 months ago
Thank you. Will ask him to test. I’m super nervous cause I do feel that something is there. What about the open lesions on my lips that lasted a few days or maybe a week? Have had painless small bumps on inner bottom lip. I know I tested confirmatory negative and I haven’t had any real symptoms of syphilis but is it possible that I have it “hidden” or some type of weird immune system where the original screening did pick it up/detect it  but for some strange reason,( maybe cause it’s so latent?), the follow up tests were negative? Can you have it for “a little while” or” temporarily” and it goes away? Is there such a thing as a “mild” case of syphillis where you don’t even notice it? I Know I shouldn’t, but I keep going back to that pink round bump that I was exposed to. There was a lot of vaginal-penile friction going on twice and oral and I feel that that person had something. I know that in females, the primary sore or chancre or even follow up ones after can be inside of the vagina where it’s not noticeable or felt. It’s easy to know you had it. Just trying to figure out how to suggest a syphillis test after a year and a half together without him taking it wrongly (that I’m accusing him of cheating or that I am). Should I mention my previous equivocal result and subsequent negatives? Should I mention exposure before he and I were together?  Should I stop having sex with him (he’ll definitely think something is wrong)? If my BF tests God forbid positive, I should re-test correct? Keeping fingers crossed that he does go ahead and test and that he comes up negative. Thanks again for everything. Your support is greatly appreciated. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
I fear you are working yourself up unnecessarily.  If you are going to the internet for guidance, please don’t.  The internet is full is misinformation which is out of date, taken out or context, just plan wrong, or blowing things out of proportion.  I am not questioning that you BF had a bump or a rash but your test results for Syphilis are clearly negative.  I hope that getting him to test will help you to move forward.  Once you have Syphilis it does not go away without treatment and even after successful treatment blood tests typically remain positive for months or even years.

I see no need for further testing but if you wish to, please only once more.  Similarly, I hope that with a negative test from your BF you will be able to move on.  There are many alternative diagnoses both for his genital “bump” and his rash.  

Typically threads are closed after three responses.  I will leave this open for one further question just in case but I can assure you, my assessment and advice will not change.  Please stay off the internet.  EWH
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8 months ago
Thank you so much. Will stay off of the internet. It makes things worse. Please don’t close the thread just yet.  I‘m just responding to clarify misinformation. I never saw a “bump” or anything else on my bf’s genitals. He’s only had the rash on his feet and the one open lesion on front of ankle. The “bump” was on the genitalia of the other person I had the two time unprotected encounter with two years ago.  Hoping I’m able to convince my bf to test, that would alleviate a lot of anxiety. Trying to put it in a way where I don’t say syphillis or std but might have to mention those terms. Knowing me, will probably test again. Will keep you posted. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Thanks for the clarification.  I won’t close the thread now but will after the next exchange.  As I suggested earlier, I would suggest that the way to,address this is to tell youBF that you were worried about him and searched the topic of rashes on the internet and it made you nervous.  Good luck.  EWH---