False positive TPHA results are rare but can occur from time to time. That's clearly the situation here, based on your other blood test results and absence of symptoms that suggest syphilis. Most syphilis experts would advise that TPHA testing never be done until and unless the standard screening tests (RPR or EIA) are positive. TPHA was developed and is intended for use strictly as a confirmatory test, not for primary screening. (The T. pallidum specific tests like TPHA, FTA-ABS, and others actually can become positive sooner than RPR and other non-treponemal tests, which has led some labs to offer them as screening options soon after exposure. But that's a mistake and I would avoid such testing if and when it is offered.)

That your TPHA result is false positive also is supported by your sexual history, which has been very safe in regard to syphilis prevention. And by its "weak" positivity.

To your specific questions:

1. You do not have syphilis and therefore could not have given it to your wife. No possibility. 

2. [missing]

3. Levofloxacin and all other antibiotics of the same class (fluroquinolones) are entirely inactive against syphilis. They cannot alter syphilis test results. That treatment made no difference at all.

4. Twelve days is too soon for any syphilis blood test to become positive, including TPHA. And that exposure, like the first, was no risk for syphilis.

5. The exposures described also were zero risk, or close to zero, for HIV. Pre-exposure prophylaxis is not likely to delay positive HIV test results; your negative test at 50 days is reliable.

6. I see no need for any additional syphilis testing. If done anyway, I suggest you avoid TPHA testing entirely. Having had one false positive result, it might occur again (or permanently).

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

HHH, MD

1. I have gone for RPR only .I usually do every year hiv and rpr ( syphilis) test..... But somehow I have decide to test TPHA also ........

I had test in March 2022  and oct 2022 RPR negative and 6th jan 2023 RpR negative ...........I have few exposure between above in 2022 and 2023 ........but never had vaginal sex ........only kissing and condom protected blowjob...........I assume they are covered by my 6th jan test .Am I correct ?

2. I have missed one question in previous two exposure I mentioned I also do french kissing ..........but didnot see any sore on lips ..............can i say that my 6th jan rpr test and Hiv test is conclusive for my 1st exposure ......and my wife is completely safe due to my above test. (Tested 50 days after 1st  Exposure ) ....sorry for asking again.

3. I have take prep on demand for every exposure truvada including last two whether body massage or penetrative sex ( condom protected) ...............can i say that I am fully safe with regard to hiv if I follow above strategy ...........I don't have any side effects and my exposure is generally once or twice in a month.

Thanks again doctor for your reply..........I watch for chancre on genital ..........if no symptom i will not test other than my routine test.

1. Given your sexual practices, I would advise against testing for syphilis after every non-monogamous exposure, but a lot less frequently -- maybe once a year -- and for those tests, to have only RPR or an EIA (IgG/IgM test); no more TPHA.

2. Syphilis is very rarely transmitted by kissing, and HIV never.

3. I would advise against PrEP on demand unless you start having significantly risky exposures. That said, it isn't harmful, so feel free to continue if it gives you confidence. But from a medical/risk standpoint, it doesn't seem necessary.

Sorry doctor I have tested again to prove tpha is false positive and you are right.

23rd Jan 2024  tested 

Rpr negative

FTA ABS negative 

After 70 days ( 15th nov 23 exposure)

After 31 days ( 26th Dec 23 exposure)

1. Latest Test ( 23rd Jan2024) is conclusive for 15th nov exposure and before ........means I was never infected ( fta abs is negative and rpr is negative). It also means 6th Jan  TPHA test  IS FALSE POSITIVE....... am I right .

2. I know 23rd jan 2024 test is not conclusive for 26th dec exposure ........but my wife is completely safe as I have touched her on 12th dec 2023 no exposure with her after that she is also rpr negative in 2015 and 2020 for pregnancy...........am I right ?

3. I have read other questions also .Fta abs is negative also prove that I was never infected or treated for syphilis since I don't have any TREPONEMAl antibodies. Am I right ?

4. One last question if during sex condom breaks then prep on demand ( truvada) will protect me from HIV at least 99.9 percent.

Am I right 

Thanks again doctor .........i think I know the replies of above questions  but want to confirm and I will follow your advice in future testing with Rpr/ eia only. Never with tpha.

All these statements are correct. I'm glad you understand. Thanks for the thanks. Best wishes and stay safe!