Around 7 years ago I had several high risk exposures (oral). I was naive and never was tested. Around the time I developed a large sore inside my bottom lip however I cannot remember if it were painful or not. I still have a swelling/scar to this day. Is this normal of a healed chancre? Around the same time I developed bad red rashes on both inner thighs, these were very itchy and burned. I know the rash can take many forms but is itching/burning a common theme? The back of my hands also became very cracked and red and dry, however I do not recall the normal palmar rash of essentially dots? Do these sound like likely symptoms to you?

I will test shortly through the NHS however I have recently taken several rapid tests which came back negative. I know these are not as accurate as traditional serology however I have read that they are treponema tests looking for IGG/IGM. I read that they are more accurate with higher titres however I am confused as I thought titres in syphilis referred more to the RPR? If treponema tests detect antibodies which last for life, surely the longer time between contraction and testing the more antibodies and therefore more accurate the rapid test might be? 

Thank you very much for your time and understanding. 

Assuming you are male (by your name). If your sex was with women, you were probably at little or no risk for syphilis; the risk was a lot higher if they were with other men. Either way, your description of the oral lesion is consistent with chancre -- and although chancres usually heal without scarring, that could happen. The rash if secondary syphilis isn't likely to be limited to the backs of the hands, and "racked", "red" and "dry" are not typical syphilis. I would be more suspicious of eczema or some other dermatitis. However, many people with syphilis never develop overt rash or other obvious symptoms, so absence of typical rash doesn't mean very much one way or the other in assessing the likelihood you acquired syphilis 7 years ago.

You're on the right track in seeking a syphilis blood test:  I would have recommended it if you had not mentioned it yourself. The IgG/IgM tests are fine, and nowadays usually are the initial syphilis blood test; they're cheaper and less labor intensive than RPR and similar tests, so no surprise that many or most NHS GUM clinics (and other clinics) may be starting with IgG/IgM. If positive, the lab almost certainly will automatically do a confirmatory RPR with titre. I'll be interested to learn your test result. I'm looking forward to hearing from you when the result is available; as well as the clinic's opinions and advice.

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

HHH, MD

The rash I recall I put moisturiser on as it stung quite a bit and was easily irritated. My palms potentially became dry and cracked along with the back of the hands however I do not believe it was ‘ditty’ or ‘spots’ so to speak - again I used a hand lotion. 

Thanks again for your help