Jeremy first noticed the spots on his palms while typing at his laptop in a coworking space in Bangsar South. Tiny reddish-brown patches, maybe six or seven of them, scattered across both hands. They didn’t itch. They didn’t hurt. They just sat there, looking like nothing he’d seen before.
“Probably some food allergy,” he thought, mentally rewinding through what he’d eaten that week. The next day he noticed similar spots on the soles of his feet. Then a faint rash creeping across his chest. He went to a regular GP nearby, who suggested it might be a viral rash and prescribed antihistamines. The rash didn’t budge. Two weeks later, a friend who works in healthcare took one look and said, “You need a syphilis test. Today.”
Most Malaysians don’t connect a rash on the palms and soles with sexually transmitted infections. But this particular pattern — copper-coloured spots on the hands and feet, often with a body rash — is one of the textbook signs of secondary syphilis. And because it’s so often misdiagnosed as a simple skin issue or allergic reaction, syphilis cases get caught much later than they should.
A Quick Refresher on Syphilis Stages
Syphilis is unusual among STIs because it progresses through clearly defined stages, each with its own characteristic symptoms. Understanding the stages helps explain why a hand-and-foot rash is such an important clue.
Primary syphilis.
Begins 10 to 90 days after exposure (average around 3 weeks). The classic sign is a single painless sore (chancre) at the site where the bacteria entered the body—usually genitals, anus, or mouth. The chancre heals on its own in 3 to 6 weeks, even without treatment. Many people miss this stage entirely, especially if the chancre was hidden internally.
Secondary syphilis.
Begins weeks to a few months after the primary chancre heals (typically 6 to 12 weeks after initial infection). This is when the bacteria have spread throughout the body, and the body begins reacting visibly. The hallmark sign is the rash we’re talking about in this article — but secondary syphilis can produce many other symptoms too.
Latent syphilis.
Without treatment, the visible secondary symptoms eventually fade, and the infection enters a quiet phase that can last years. The bacteria are still present and can still be transmitted, but the patient has no obvious symptoms. This is why so many syphilis cases are caught in unrelated routine blood tests.
Tertiary syphilis.
In some untreated patients, syphilis eventually causes severe damage — to the heart, brain, blood vessels, eyes, and other organs. This stage can develop years or decades after the original infection. Modern antibiotic treatment in earlier stages prevents this almost entirely.
What Secondary Syphilis Rash Actually Looks Like
Secondary syphilis is sometimes called “the great imitator” because it can mimic many other skin conditions. But there are some characteristic patterns worth knowing:
The rash on palms and soles is the giveaway.
Most rashes don’t appear on the palms and soles — those areas have unusually thick skin and a different blood supply pattern. When a rash does show up there, the differential diagnosis narrows quickly. Secondary syphilis is one of the few conditions that classically produces palm-and-sole rashes. Others include certain viral infections (hand-foot-mouth disease), but these have very different patterns.
The rash is usually:
- Reddish-brown, sometimes called “copper-coloured”
- Flat or slightly raised round spots
- Not itchy (in most cases — this distinguishes it from many allergic rashes)
- Often appears symmetrically on both hands and both feet
- May also spread to the trunk, arms, and legs
- Can come and go over weeks if untreated
Other secondary syphilis symptoms to watch for:
- Mild flu-like symptoms (low-grade fever, fatigue, headache, body aches)
- Swollen lymph nodes (especially in the neck, groin, and armpits)
- Patchy hair loss in the scalp, eyebrows, or beard
- Mouth ulcers or moist patches in the mouth or genitals
- Sore throat
- Unintentional weight loss
Many patients have only some of these symptoms, and severity varies a lot. The rash is often the most consistent finding — and it’s the one that brings people into clinics, especially when they realise it doesn’t behave like a regular allergic or viral rash.
Why Syphilis Is Rising in Malaysia
Syphilis cases have been increasing in Malaysia and across Southeast Asia over the past several years, after decades of relatively low rates. The rise has been seen across all demographics, though particularly in younger adults and in men who have sex with men.
Several factors contribute to this trend. Reduced fear of HIV (thanks to effective treatment) has led some to perceive sexual encounters as lower-risk overall — overlooking other STIs. Online and app-based dating has increased the number of new sexual partners many people have. And public awareness of syphilis specifically has dropped, since for many years it wasn’t being talked about much.
In Klang Valley, we’ve seen the number of syphilis diagnoses at our clinic rise notably year on year. Most of these cases are caught at the secondary stage — often by patients who initially thought they had a skin condition or allergic reaction.
How Syphilis Is Diagnosed
The diagnosis of syphilis at any stage relies primarily on a blood test. There are typically two types used together:
Non-treponemal tests (RPR or VDRL).
These detect substances the body produces in response to syphilis infection. They’re useful for screening and for monitoring whether treatment is working.
Treponemal tests (TPHA or FTA-ABS).
These specifically detect antibodies against the syphilis bacterium itself. They confirm whether you’ve ever had syphilis. Once positive, they usually remain positive for life — even after successful treatment.
In our clinic, both tests are usually run together for a complete picture. Results are typically available within 2 to 3 working days. If you have visible secondary symptoms like the palm-and-sole rash, the doctor may also examine the rash directly and order additional tests if there are any concerns about other coexisting infections.
Because syphilis significantly increases the risk of HIV transmission, and the two infections often coexist, an HIV test is almost always run alongside syphilis testing. This is standard practice — not an accusation. Catching both, if both are present, allows us to treat both effectively.
Treatment Is Surprisingly Simple
Here’s the genuinely good news. Syphilis at the primary, secondary, and early latent stages can usually be cured with a single dose of penicillin — typically given as an injection. Late latent syphilis or tertiary syphilis may require a longer course of injections, but treatment is still highly effective.
After treatment, follow-up blood tests are done at 3, 6, and 12 months to confirm the infection has been successfully cleared. The non-treponemal test (RPR/VDRL) titers should drop significantly over time — a clear, measurable indication that treatment worked.
Important to know: even after successful treatment, you can be re-infected with syphilis if exposed again. The infection doesn’t grant lasting immunity. Safe sex practices remain important, and people in higher-risk situations may benefit from regular screening every 3 to 6 months.
Jeremy's Story — Caught at the Right Time
Jeremy came in for testing on the same afternoon his friend told him to. Blood drawn at noon. Results back two days later — secondary syphilis confirmed, HIV negative. He received a single penicillin injection at our clinic, took the day to rest, and within two weeks the rash on his palms and soles had begun to fade. By the six-week mark, his skin had completely cleared and his follow-up blood test showed treatment was working.
“The scariest part was the two weeks I spent thinking it was just a weird allergy,” he said. “I had no idea something this serious could look this… casual.”
This is exactly why we wrote this article. Most of our patients with secondary syphilis tell us the same thing — they just didn’t know what they were looking at. Once you know, the dots connect quickly.
Get Tested at Dr Prevents
If you’ve noticed an unexplained rash on your palms, soles, or chest — especially in combination with mild flu-like symptoms or a recent unexplained sore that healed on its own — please get tested. At Dr Prevents, syphilis screening is part of our standard STI panels, with confidential blood testing available at our KL and Selangor clinics.
Walk-ins are accepted, results are typically returned in 2 to 3 working days, and treatment can usually be started immediately if needed. The test costs less than a nice meal at a mid-range restaurant. Your peace of mind is worth far more.
📞 Trust your gut. Get the rash checked. 🩺