[Question #10480] worried re no doctor response
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22 months ago
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Dr. H 10/29/14 positive for syphilis. Dx secondary. RPR 1:256. Dr gave 2.4 mil pen. shot. Specialist ordered 2 more shots of 2.4 mil each. 1st 11/13/14 & 2nd 11/20/14. 5/15/15 RPR therapy test 1:16. Specialist said tx worked, bacteria dead, no further tx needed, not contagious. 9/25/23 saw family dr for unrelated issue. Summary said problems= syphilis onset 11/2014, status "active." Called specialist, ass't said test went down more significantly than 4 fold, tx worked, bacteria dead, no further tx, not contagious. Wrote to specialist confirmed above said "please advise if any of above is not accurate or if syphilis not killed by 3 shots". No response. 1. Have I had active syphilis since 2015? 2. Could syphilis, have been latent not secondary, given specialist order for 3 total shots? 3. Whether sec. or latent, would 3 shots 2.4 mil penicillin killed syphilis, even though 2 weeks between 1st & 2nd shots? 4. Do I need any further testing &/or tx? Subseq. found out family record was computer mistake. Also, have had 2 10 day courses doxycycline for sinus infection 1/2018 & 6/2021, if that matters. Can provide more details if needed. Thank you.
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H. Hunter Handsfield, MD
22 months ago
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Welcome back. But I have to start by saying I am extremely puzzled that you said nothing about your past syphilis when you posed your question 3 months ago about a possible syphilis exposure. Had I known about this history, I would have suggested syphilis testing, just on general principles-- rather than waffling a bit and calling it optional.
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The other missing information here, therefore, is whether you in fact had syphilis testing after the discussion. If not, you definitely should do it now. Based on the information provided, it seems you were treated appropriately nine years go; and although one doctor's comment ("status active") is a bit confusing, if indeed your RPR titer declined "more significantly than 4 fold" (e.g. to 1:32 or lower), you met standard criteria for cure. I would speculate that the word "active" meant your doctor considered the issue open and not completely resolved in that you still were concerned about it, and not that he thought you still had active syphilis.
That said, even meeting the 2-dilution i.e. fourfold titer criterion decline (two dilutions), for patients with initial RPR as high as 1:256, many syphilis knowledgeable physicians would have continued testing afterward -- maybe even a year or two -- to document continued decline (it would be hoped) thereafter, in order to know the patient's post-treatment baseline, which someday might be the main way to know if there had been a relapse or if a new exposure led to infection. Did you have no further testing beyond a few months?
In any case, my ONLY advice at this time -- entirely independent of your questions 3 months ago -- is to either tell me the RPR results after our last discussion, or to have an RPR now and let me know the result.
1. I doubt you still have syphilis, but a blood test is the way to know.
2. Three doses of benzathine penicillin G (BPG) is routine for syphilis a year or more in duration, or if there is any uncertainty along those lines. Even for earlier infection including diagnosed secondary syphilis, some specialists have more conservative perspectives and like to err on the side of over treatment. I have no way to judge at this time. Have a blood test.
3. Yes: BPG provides anti-syphilis levels in blood for 2 and even maybe 3 weeks. Two weeks between doses is fine. Have a blood test.
4. Yes. Have an RPR.
Having had doxycycline makes it even less likely you have active syphilis. But it still makes sense to have a blood test.
Perhaps you're sensing a theme here. I suggest we have no further discussion until and unless you are retested and would like to return to let us know the result. You just have an RPR screening test (which will be positive so no point in doing it).
I hope these comments are helpful. Let mw know anything isn't clear.
HHH, MD
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22 months ago
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Doctor handsfield, thank you for your reply. I guess I didn't think having syphilis 9 years ago, which I understood was cured was important when I asked you a question 3 months ago. I apologize for that. you say in your response "you just have an RPR screening test (which will be positive so no point in doing it)" I am confused by that. I believe earlier in your reply you wanted me to do an RPR test? My titers after TX in 2014 went down to 1:16 from 1: 256, if that wasn't clear. Thx and again I'm sorry
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H. Hunter Handsfield, MD
22 months ago
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Sorry -- an editing error as I was typing; some words got deleted unintentionally. The intended statement was "You [should] just have an RPR, not an EIA or IgG screening test (which will be positive so no point in doing it)." Apologies for the confusion.
I'm glad to hear your RPR declined to 1:16. That well exceeds the fourfold (two dilution) decline that documents cure. I'm betting that an RPR titer will be still lower at this time and perhaps even negative. If so, it will assure you were cured and also not reinfected during the exposure we discussed three months ago.
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