My concern is a false negative for myself or a false negative due to prozone effect. I am concerned because I was recently diagnosed with mild hemolysis. I did a direct and indirect Coombs test and both were negative. I have read that could be due to PCH Anemia. I have been borderline anemic for years but not truly anemic to cause issues. I had read that PCH in adults can be caused by syphilis. I have two specific questions: 

Is it possible my qualitative rpr test in 2014 was false negative and I have had an infection for the past 10 years with no noticeable symptoms and that is causing my hemolysis? 

And my partner has tested negative twice while I have been infected despite 9 years of unprotected sex?

Thank you 

The rapid plasma reagin (RPR) test is highly accurate; a negative results is conclusive evidence against active syphilis. Negative results can occur at long intervals -- usually mean years -- after successful treatment of syphilis, or if the infection has been controlled by the immune system. But a negative result always means that there is no current, active infection. Stated another way, in someone not treated for syphilis, a negative RPR is proof that syphilis is absent and the person probably never had it.

Syphilis indeed has been associated with paryoxysmal cold hemolytic (PCH) anemia, but very rarely; I've never seen nor even heard of such a case. And when it happens, it typically is in the context of overt syphilis, usually in the secondary stage with all its obvious symptoms. Certainly it has never been the only evidence of syphilis, and also cannot occur with a negative RPR test. Also, it sounds like you have been at close to zero risk of syphilis, unless your past sexual history includes multiple sexual contacts with other men. Syphilis remains rare in heterosexuals in the US, and was even rarer more than a decade ago. And still another factor is that apparently you never had symptoms of primary syphilis (a painless ulcer at an exposed site, usually the penis) or secondary syphilis (widespread skin rash plus other symptoms). On top of all this, it is clear you never infected your wife with syphilis.

All things considered, there is no chance you have syphilis, not withstanding your PCH. You needn't be even remotely worried about it. However, if you would like confirmation, you could have another test, this time asking your doctor or the lab to do one of the enzyme immunoassays, i.e. to test for syphilis IgG/IgM antibody. This is now used equally commonly as RPR for syphilis screening. A negative result would nail down any possibility of syphilis. If somehow I were in your situation, I wouldn't feel any need and wouldn't do it. But it's available if the negative result will help convince you.

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

HHH, MD

1.Is the prozone effect a concern? I only ask because I read it can happen during secondary stage and I was tested at 8 months post exposure which would put me in secondary stage.

2.I have not been diagnosed with PCH just hemolysis. And I haven’t had symptoms consistent with secondary stage. 

3.Finally the fact my partner had two negative tests two years after mine would that suggest I didn’t have it and didn’t pass it on to her? And we are not infected? 

2. Other hemolytic anemias may be associated with syphilis; this doesn't alter my comments or advice.

3. Correct. This what I was referring to with "On top of all this, it is clear you never infected your wife with syphilis."

1. I had a qualitative RPR 9 years ago. It did not say anything about a quantitative test. Is there a major difference? I have no idea if they did one. I only saw the labs from my DR which included all of cbc and other blood panels. 

2. I looked up the qualitative test on Labcorp’s site since that’s where my results were sent 9 years ago. And on their site it states not to use the qualitative test for screening only to use it for monitoring response to treatment, why would that be there now? 

There is no possibility you have syphilis now, and almost none that you ever had it. Believe it and do your best to move on without worry. If you cannot, have an EIA test as advised above.

That completes the two follow-up exhcanges included with each question and so ends this thread. Please accept the professional, expert, reasoned science based reassurance you have had here, and perhaps from your own doctors. Good luck.