[Question #1011] ABSOLUTELY CONCLUSIVE????

49 months ago
Hello...I will try and make quick. I had some high risk(non-protected) going back to mid 2009.  Since that time I got tested multiple times for all STD.  I started testing in 2010 which included HIV tests of 3 and 4th generation along with RNA and DNA tests, up until January of 2015.  All have been negative.  In the same breath I also tested for all other STDs.  Starting in 2010 and until 2015 I tested ALOT for HIV x 30, syphilis with the RPR x 12, TPPA x3 , TP- antibody(Trep-Sure)x 6 and FTA-ABS x 6.  Things were going great until back in January of '15 I tested again for peace of mind for all (HIV 4th gen, RPR, FTA-ABS, Tp-antibody.).  All was good execpt i got positive FTA.  I repeated it a week later, and month later, and then 9 months later--Negative.  I have had no exposures since 2009.  I have all sorts of weird things with my body that cannot be explained and doctor is lost.
1)Can I be ABSOLUTELY sure  I do not have HIV or syphilis with all my negative tests?
2) IS there a chance that ALL but the one positive tests for syphilis are false negative?
3)Do i need to test anymore?
4)Any chance that ANY strain/subtype of HIV can be missed with combo testing for hiv1/2 or do you need separate to be absolutely sure?
5)NO matter what is occurring with me, can i be sure that I am not a health threat to my wife?
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago

Welcome to our Forum.  I'll be please to comment.  You are a a "poster boy" for why we tell our clients that excessive testing is not a good idea.  Clearly your isolated positive FTA (a test which has a certain amount of subjectivity in its interpretation) was falsely positive.  the probabilities of false positive tests increase as the numbers of tests performed increase.  You need to accept you results and move on. 

1)Can I be ABSOLUTELY sure  I do not have HIV or syphilis with all my negative tests?

Yes, see above.


2) IS there a chance that ALL but the one positive tests for syphilis are false negative?

Simply not a reasonable interpretation of the results you report.


3)Do i need to test anymore?

No, please stop testing!


4)Any chance that ANY strain/subtype of HIV can be missed with combo testing for hiv1/2 or do you need separate to be absolutely sure?

Please stop testing and believe your test results.


5)NO matter what is occurring with me, can i be sure that I am not a health threat to my wife?

Clearly you are not a threat to your wife for any of the tests you have tested for. 

I hope these comments and answers are helpful to you.  EWH

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49 months ago
Thank you so much for answering.  From what I have been told these tests are final and absolute, but if you could clarify a few things and expand on them I would really appreciate it.
1)When you say that the FTA is subjective, how is that?  Isn't it a Yes or No result?
2)Is there EVER a time where after say even a year after exposure or even if you have LATE syphilis, that your treponemal(FTA. TP antibody, TPPA) as well as the RPR could be negative in serum blood tests but detected ONLY with spinal tap or is that not possible?
3)If i had been exposed earlier than thought, could a person be more infected an show all negative on HIV pcr, RNA and antibody tests?
4)Do the HIV tests cover essentially every strain out there?
5)NO MATTER WHAT symptoms I have, or how strange they are, I can FULLY put to rest these two diseases without a doubt?
Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
I will try to reassure you with questions which essentially repeat the reassurance I have already attempted to provide however your testing history and questions make me worry the you might benefit more from counseling to help you deal with continuing, unwarranted concerns than any amount of testing.  I say this out of concern for you, nothing more.

On to your questions:
1.  The FTA test is a fluorescent antibody test in which positivity is determined by the degree of fluorescence with low levels of fluorescence being negative.  The fluorescence is judged by the reader and thus subject to reader to reader variation.  

2.  No.  There is no need for you to have a lumbar puncture.

3.  No, believe you test results.

4.  Yes.

5.  Yes, you really need to believe your test results.  Please consider my recommendation for counseling.  EWH
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49 months ago
Thank you so much for your reply. What really scares me is stuff my wife gets from time to time as well. Oral sores/unusual rashes. Out of nowhere. I know I've been tested but can you please answer these?
1)does the fta always remain positive 
2)can you get a falsely negative rpr, fta, and tp-antibody tests,  all at the same blood draw years (more than 3) after first symptoms?
3)how good(sensitive) are the syphilis tests I've had?
4) how likely is it that for some reason,   The third and fourth generation tests for HIV would miss it years after exposure?
5)can a person always show sero-negative on tests but have HIV?
6)so no matter what I feel, what symptoms me or wife gets, HIV and syphilis are ABSOLUTELY excluded and  crossed off the differential?
Thank you very much. 

Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago

This is my third reply.  In it I will repeat much of what I have already said.  As my 3rd reply to your questions it will also be the final reply in this thread which will be closed later this evening. 

1)does the fta always remain positive 
Yes in patients with established syphilis tests like the FTA typically remain positive for life. 

2)can you get a falsely negative rpr, fta, and tp-antibody tests,  all at the same blood draw years (more than 3) after first symptoms?
If untreated, no you cannot.

3)how good(sensitive) are the syphilis tests I've had?
the tests you have are excellent and the results, with the exception of your single false positive FTA all agree with one another.  You should believe them.

4) how likely is it that for some reason,   The third and fourth generation tests for HIV would miss it years after exposure?
Not likely at all

5)can a person always show sero-negative on tests but have HIV?
Only in the first few weeks after infection. From then on tests will be positive.

6)so no matter what I feel, what symptoms me or wife gets, HIV and syphilis are ABSOLUTELY excluded and  crossed off the differential?
As I said before, these infections have been excluded by the test results you report. 

I hope you can move forward.  You need to.  Please consider my comments about counseling made in my second response.  EWH

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