[Question #11843] Syphillis Testing
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12 months ago
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I have had gaps in testing where about 6 years have gone by from my previous RPR test (being negative) where a couple M2M oral encounters have occurred without immediate follow up syphillis testing. I never noticed symptoms post encounter. Recently went for a test which was RPR and was non reactive. My question is what are the possibilities that in 2-3 encounters of oral mostly receiving that I could have caught syphillis without knowing and that the test where 6 years have gone by shows up non reactive but there could have been an infection where antibodies have disappeared - showing the negative test 5 years later. Just reading that the RPR doesn’t necessarily mean you never had an infection. There were only a couple low risk opportunities but wondering what are the chances.
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H. Hunter Handsfield, MD
12 months ago
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Welcome to the forum. Thank you for your confidence in our services.
You needn't worry. While it is true that the RPR can become negative in untreated persons with syphilis, it is very rare and certainly doesn't happen in under 6 years. Your recent negative test is solid evidence you were never infected. The only slight possibility is that you acquired syphilis that was treated effectively -- for example, if you received antibiotics for something else, such as a respiratory or skin infection, without knowing about the syphilis. But in this case, it is clear that you no longer have it. In addition, you also were at little risk, since syphilis is infrequently acquired by oral sex; and since the exposed sites are obvious (your penis and perhaps mouth?), it is unlikely you would have been unaware of a syphilitic chancre. (Unlike the occurrence of internal chancres from anal sex, for example.)
The bottom line is that you can be very confident you do not have syphilis and never did.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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12 months ago
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Thank you. I’ll just follow with one question:
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H. Hunter Handsfield, MD
12 months ago
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Doxycycline is highly active against syphilis -- the main treatment advised when penicillin isn't available or appropriate (e.g. allergy). When taken after exposure and before onset of symptoms, or before a positive blood test, the standard dose used for most infections (like chlamydia, for example) -- i.e. 100 mg twice daily for a week -- it is 100% effective in aborting or curing an incubating infection. It also would be expected to cure an established infection, even though the formal recommendation is for two weeks treatment.
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Don't overthink this straightforward situation: you can be entirely certain you do not have syphilis.
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12 months ago
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I know I don’t have it but curious about the gap time if I ever had it. So I guess I’ll ask it a different way. Is there a test that can say whether you have ever had it versus the RPR which doesn’t tell you that. You can close out after your response and thank you..
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H. Hunter Handsfield, MD
12 months ago
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No, there is no such test and it doesn't matter anyway. Even with the theoretical possibility you were exposed, infected, and treated (with incidental doxycycline) and now have a negative RPR I stress "theoretical". I've never once heard of this actually happening, certainly not within a 6 year period. Also, in that circumstance there is no chance you could have transmitted it to someone else in absence of symptoms. Go forward with 100% confidence you do not have syphilis and never did. Just let it go.
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That concludes this thread. I hope the discussion has been helpful.
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