[Question #7767] Syphilis Question

1 months ago
In 1996 I had a full body rash non itchy and included the palms of my hands.  It was a rash flat red dots. Felt fine no fever etc.  It occurred when I took my boards so maybe it was related to anxiety?  I also was on bactrim and I stopped taking the med and never went back to the doctor and just assumed I had a sulfur allergy.  About 5 years later I had what appeared to be a scab on head of penis that I noticed while taking a bath.  It just fell off, the scab that is.  I never notice anything on my penis before  as this was the first time in the bath I noticed, and I imagine I would have noticed something on my penis before so I’m not even sure what it was.  I went to my MD for my physical around the same time and he initially look concerned but asked me how long was it there for and I said only a day and then he just said to come back if it returns which it did not.  I know the ulcer happens first and then a rash so it’s out of order but it’s always stuck in my mind and I haven’t totally been able to get over it and officially rule syphyllis out.  I’ve had many RPR test, like a couple dozen over the last two decades via routine std testing and all negative.  I did bring it up with an NP probably 15 years ago and she I believe ordered another type of test and that was negative.  I officially want to put this away and not worry anymore.  My question:  I’ve read that RPR can be less accurate in later stages, but isn’t is very safe to say that if I have had that many RPR that the possibility of it being a false negative is close to nil?  Is there a test I can take to 100% rule out syphyllis?  I appreciate your help, I asked a question a month ago and it was very helpful to me.  
1 months ago
Additional info- I’m a gay male so I know the risk of exposure is higher.  I’m working with a therapist to get past a my last STD worry and as mentioned the prior question I asked a month ago and your response was helpful.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Welcome back to the forum. I'm glad we were of help last time; thanks for the thanks.

There is no chance you have syphilis. While your description of the rash is consistent with syphilis, there are many other conditions that cause the same sort of thing. Allergy to sulfamethoxazole-trimethoprim (either drug) is a far better explanation. The penile scab could not have been syphilis -- although it does raise the question of genital herpes, by far the most common cause of penile sores tha lead to scabbing. (Syphilis does not.) And you multimple negative syphilis blood tests show you do not have active syphilis now, and there is no reason to seriously suspect you ever did. -- syph

You're of course right that STDs are especially common in men having sex with men. But it's not the gender of partners that matters -- it's their sexual lifestyle. If you continue to have sex with other men outside a committed monogamous relationship, you should have routine STD testing from time to time-- syphilis and HIV blood tests, and gonorrhea and chlamydia testing of potentially exposed anatomic sites, depending on your sexual practices. But you needn't be at all concerned about currently having syphilis. No way.

I hope these comments are helpful. Let me know if anything iisn't clear.

HHH, MD
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1 months ago
Ok thanks!

I think over time I’ve come to that conclusion as well.  I’m confident I don’t have active syphilis.

I do have two follow up questions though.

1.  Given that this had happen so long ago, and my memory of when I had my first RPR is questionable I am a little concerned maybe I had it when I first met my partner 20 years ago?  So my question is if the NP 15 years ago  that did that other type of test if it was a FTA-ABS and it was negative isn’t that 100% proof the incident was never syphilis in the first place?  Doesn't the FTA-ABS usually stay positive when one has syphilis ..for life?  I think my real worry is this something I could have passed on to my partner years ago? I really don’t remember when I started getting tested for syphilis.  I don’t believe it was standard with std testing at that time to include an RPR.  Should I just get a FTA-ABS to move on from that?

2.  I’m generally in a committed relationship with the same partner of 20 years, but when I do go outside of it I get a STD at the right time after the incident, I occurs maybe most once per year.  I want to confirm what you recommend for a standard STD panel? I usually get a urine GC and Chlamydia and mouth swab don’t need an anal but sometimes get it anyway.  Syphilis and then an HIV. I don’t get herpes testing many because I don’t have any out breaks and I’m sure I have HSV 1 anyway.  Do you recommend any other test to be in a standard STD panel?  Trich?  Uroplasma Mycroppasma?  

Thanks for your help!
1 months ago
Just correcting what I wrote “I get an STD test at the right time”
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
1. Any and all available syphilis tests would have been positive at that time, if your rash was caused by syphilis. Anyway, you can be sure the NP dien't do an FTA-ABS. That test is never done unless an initial screening test, such as RPR, is positive.

2. Your testing sounds perfectly appropriate. I do not recommend any "standard" panel; many labs' panels include unnecessary tests. As I said above, the only tests I would recommend are blood tests for HIV and syphilis and anatomic site-appropriate tests for gonorrhea and chlamydia. Trich is strictly a heterosexually transmitted infection. Ureaplasma rarely causes disease and tests for it are almost never appropriate. Mycoplasma hominis:  no. M. genitalium:  too newly recognized and studied to know for sure about MSM, but in any case testing is not warranted in males in the absence of urethritis (penile discharge etc).
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