[Question #11144] Followup
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16 months ago
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Hello Doctor. I had some more followup questions. Before that, just to clarify, the ex-pat assumption made by you was incorrect. I need to travel to a little far to get these tests done and for doing so, I would need to cook up believable stories to convince my family. I just wanted to confirm with you the risk factor of stalling the tests for a while to avoid such a situation, so that once am back to the city where I work, I am on my own and can do the tests immediately. However your last response made me worried and I managed to get tested for syphilis, Gonorrhoea and Chlamydia (didn’t to HIV because am waiting for 90 days period to over). syphilis, Gonnorhea results are negative. Waiting for the Chlamydia results. The syphilis and chlamydia tests are done using blood sample and gonorrhoea using the urine sample. Following are my doubts.
1. The syphilis test was VDLR, and I read online that VDLR could give false negatives at the beginning or later stages of syphilis. What would you advise on this? Are my results conclusive enough or should I go for further conclusive test? If yes, what type of test would that be? Just for context, the sexually active period was from July 2023 to Jan 2024. No other sexual contact of any form prior to that except once in December 2022 (a single time unprotected oral (both ways) with female. It was a date. And she told me its her first time).
2. From the last 3-4 days, I am having very mild dizziness every now and then. Given the possibility of a false negative VDLR syphilis result, and a possibility of syphilis affecting brain (neurosyphilis), am really worried. Apologies, if my questions are coming out of anxiety but what would your insights be on this?
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H. Hunter Handsfield, MD
16 months ago
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Welcome back. Sorry you found it necessary, but I'm glad to see the negative test results. I'm also glad to better understand the personal reasons for being careful about when and how you are going about testing: very reasonable.
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Re HIV testing: 90 days is old news for conclusive testing. The standard antigen-antibody (AgAb, i.e. 4th generation) HIV blood tests are conclusive 45 days after the last exposure, i.e. would be conclusive now. The lab-based standalone antibody tests are conclusive at 8 weeks, so enough time has passed for these as well, if they are what you can easily access at this time.
Chlamydia blood tests are not helpful at all. A negative result does not rule out a current infection; and many positive results are due to distant past infection, or are due to infections with related non-sexually transmitted types of chlamydia. Proper chlamydia testing requires a urine or urethral swab sample. Most standard gonorrhea tests automatically include chlamydia, even if that was not reported to you or the doctor or clinic where you were tested. You might make some inquiries about it. That said, the chance you have chlamydia is near zero: the vaginal sex was condom protected, and unlike gonorrhea, chlamydia transmission by oral sex is very rare.
1. You have misunderstood something you read about the timing of false negative VDRL. It always is positive 6 weeks or more after being infected. It can become negative again only after many years. In other words, your current negative VDRL is conclusive.
2. It is not possible to have syphilis symptoms with a negative blood test. And dizziness is not a symptom of early syphilis or of neurosyphilis. You cannot possibly have neurosyphilis. (It also is extremely unlikely to have syphilis without having experienced an obvious chancre, i.e. the open sore of early syphilis, which would be on your penis. All in all, you can be completely certain you do not have syphilis.
I hope these comments are helpful. Let me know if anything remains unclear.
HHH, MD
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