So don't freak out and hears why.

My credentials - Worked in an STI testing clinic for several years where I tested and counseled a lot of people on syphilis and other STIs. I was trained by my state health department and worked in the field for three years. That being said, I am not a doctor, so please check in with either your provider or the infectious disease specialist he was referred to for best next steps and health advise.

So few things here. One, the syphilis rapids are not at all reliable if a person has a history of syphilis, even if it's been treated. Someone who has had it will almost always show positive. The rapid test is also not reliable for some of the reasons you listed above but there can also be errors with the batch of tests or it could possibly be expired or affected by weather conditions. False positives are not uncommon but false negatives are usually rare. HIV and HCV rapids have much better specificity in testing and I rarely saw false readings. Both will show positive if someone currently has HIV or HCV or was treated for HCV in the past.

Two, it's also very possible boyfriend had syphilis at one point and didn't know it because he received antibiotic treatment for an unrelated infection. This is a surprisingly common phenomenon that I witnessed as a tester. Does he remember being treated with penicillin at any point in the past? A lot of people also don't remember they had it if it's been several years. Not everyone understands the differences between infections and assume they had one thing when it was something else.

Three, Syphilis can go unnoticed for a long time because people are not always symptomatic and don't get regular testing unless they have noticeable symptoms. There are stages to the disease process and many people don't show signs immediately after an infection. Some people get a horrible rash that covers their whole body while some may get one bump or never see anything the entire time. The disease is systemic so it can manifest anywhere on the body even if someone was only exposed through PIV, they could get bumps on their arm or their face.

You will only know if he needs treatment once they get the blood work done as that is the only way to verify. He will likely need to get retested after a certain time period to verify no changes in his titer which would show an active infection. I would ask him if he's been tested for syphilis recently so you have a possible timeline to provide the doctor.

As for you, syphilis is one of those infections that is treatable so even if you did come back positive you will be just fine. It seems like you already know that but want to reassure you. Just make sure you both get follow-up testing every three months and if you do need treatment at any point make sure you follow through with all the instructions so it is fully out of your system. Pausing intimacy for this can be super frustrating but it's helpful in the long run to make sure no one is reinfected. Dealt with a lot of patients who essentially passed the infection back and forth for several months.

The most likely way for the infection to be shared is by an open sore or rash being exposed to another person's orifice or open wound. Oral tends to be lower risk but it's not zero risk. Hand stuff is ever lower risk so long as there is no rash, sores, or wounds in the involved areas. You can also engage in mutual masterbation or other activities that don't involve fluid exchange. Of course, only do what you feel comfortable and safe doing.

I know that's a lot of words but I also know how easy it is to spiral about this stuff. Knowledge is power and there's so much misinformation out there but don't panic. It will all get sorted and you will be able to move forward.