Syphilis is having a major resurgence, especially among sexually active gay and bisexual men—and the first sign might be easy to miss or even easier to misdiagnose. If you've ever had a mysterious sore in your mouth, on your penis, or around your butt that didn’t hurt much and healed on its own, you may have brushed it off. But that might not have been “nothing.” It could have been primary syphilis.
At Tom of P-Town Health, we want to make sure you have the facts—especially because many providers unfamiliar with sexual health or STI diagnosis miss the early signs of syphilis or don’t order the right tests.
Let’s talk about how to recognize primary syphilis, what testing is needed, and how you can advocate for yourself if you think you’ve been exposed.
🔍 What Is Primary Syphilis?
Primary syphilis is the first stage of syphilis infection. It usually shows up as a single sore or ulcer (called a chancre) at the site where the bacteria entered your body. Most commonly, this appears on the penis, anus, rectum, mouth, or lips—depending on how you were exposed. The sore is often:
Painless
Round or oval
Firm, with a clean base
Not accompanied by pus or discharge
Here's the tricky part: the sore heals on its own in 3 to 6 weeks, even without treatment. But if left untreated, the infection does not go away—it just moves on to secondary syphilis, which affects your skin, lymph nodes, and organs.
⚠️ Why the RPR Test Might Miss It
When you go in for STI screening, most providers order a test called an RPR (Rapid Plasma Reagin). It’s a blood test that looks for your body’s immune response to syphilis—not the bacteria itself. That means it can take several weeks after infection for the RPR to turn positive.
In primary syphilis, the RPR is often negative.
Yes, you read that right: If you're in the early days of infection, a negative RPR does not rule out syphilis.
This is a fact that many non-STI-specialist providers do not know. They may tell you everything looks fine based on that one negative test, when what you actually need is a direct detection test, such as:
🤪 Testing for Primary Syphilis: What Works
If you have a sore and suspect it could be syphilis (especially if it’s painless and in a sexual exposure site), here's what should happen:
Darkfield microscopy (rarely available): This can visualize the syphilis bacteria directly from the sore.
PCR testing: Some specialty labs can detect Treponema pallidum DNA from swabs of the lesion.
Treponemal antibody tests (e.g., FTA-ABS, TPPA): These may become positive before the RPR, and a positive result can raise suspicion even if RPR is negative.
Repeat RPR in 1–2 weeks: If early syphilis is suspected, and RPR is negative, retesting soon after can catch seroconversion.
At Tom of P-Town Health, we use clinical suspicion, physical exam findings, and a combination of tests—not just the RPR—to diagnose and treat early syphilis effectively.
💉 How Is Primary Syphilis Treated?
Treatment is simple and effective: one shot of long-acting penicillin (Bicillin L-A), injected into the gluteal muscle.
If you’re allergic to penicillin, other options like doxycycline may be used—but penicillin is always preferred if possible.
The earlier syphilis is treated, the easier it is to cure—and the less damage it can do to your body (or the bodies of anyone you care about).
🗣️ How to Advocate for Yourself
If you think you’ve been exposed to syphilis or have a suspicious sore, here’s how to speak up:
Ask directly: “Could this be primary syphilis?”
Mention that RPR can be negative early on, and that a treponemal test or lesion swab may be appropriate.
If your provider seems unsure, consider seeking out a sexual health specialist or clinic with STI expertise—like Tom of P-Town Health.
Remember: you are not being difficult. You are advocating for your health.
🧠 Final Thoughts
Primary syphilis is sneaky, but it’s beatable—if you catch it early. Too many providers miss it because they rely on a single test that often doesn’t work in the earliest phase. Know what to look for, ask the right questions, and don’t be afraid to educate your provider if you’re not getting the answers you need.
At Tom of P-Town Health, we take syphilis seriously—and we treat it early, accurately, and confidentially.
📍 Worried about a sore? Think you’ve been exposed?
Reach out. Schedule a visit with a provider. If you're in P-Town contact us we'll take a look, talk it through, and get you the care you deserve—no judgment, just smart, science-based sexual health.
Comments
Post a Comment