[Question #11861] Do I have Syphilis?
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11 months ago
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Hi Doctor,
I had unprotected oral & vaginal sex with a female about 32 days ago and wanted to know my probability of potentially having Syphilis. About 7 days after our interaction, I started to have some symptoms of a headache, fever, and nausea. Then, I discovered a small ulcer on the shaft of my penis about 10 days post interaction and got swab tested for herpes, which came back negative. From there, I've started to show various symptoms including: persistent fever (99 to 101), headache, nausea (esp after eating), swollen lymph nodes near neck, and mild sore throat. About 3 weeks after the interaction, most symptoms have been alleviated.
So far, I've done the following tests:
- HIV RNA test at 11 days, 15, days, and 21 days (all negative)
- Full panel STD test (including RPR, Rfx Qn RPR/Confirm TP test for Syphilis) at 7 days and 32 days post interaction which all came back negative.
If I did have a visible ulcer 10 days after post exposure, then would it be possible that the Syphilis test at 32 days post interaction can still be a false negative? The female (who is a nurse) also did a full panel STD test 10 days after our interaction and tested negative for everything.
Thank you.
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Edward W. Hook M.D.
11 months ago
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Welcome back to the Forum. You've now absolutely PROVEN you did not acquire HIV from the encounter you have described. Relevant to your question about syphilis, your test results also prove that the sore you noted on your penis at day 10 was not syphilis- if it had been, your day 32 RPR unequivocally would have been positive. Further, while official recommendations state that a syphilis blood test can take up to 3 months to become positive, we, as well as most experts feel that this recommendation is out of date and that nearly, if not, all persons who acquire syphilis will have positive syphilis blood tests within 30, and certainly within 6 weeks of an exposure.
You're partner's negative STD panel 10 days after the encounter also confirms that you were not exposed to syphilis. If you had been, her test would have been positive by day 10.
I hope this information is helpful. Please don't worry. It's time to move forward from your doubts about this encounter. EWH
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11 months ago
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Thank you for the affirmation on the HIV Dr. Hook, I have now thankfully closed that assumption on my end (very grateful).
On your point about the early onset of the ulcer, I do also believe that the RPR test would've been positive by now if it was caused by Syphilis. The reason why I'm still anxious is that I've heard some stories about people who've tested negative initially (after a month) but tested positive after 3 months. Or those who've tested positive after a 1 year and what not.
Based on my 32 day test results, would you say I should be pretty confident that I do not have any form of STIs including syphilis?
Do you recommend I get re-tested at 6 weeks to be 99% conclusive? And if so, will I need to another full panel STD test or just re-test for Syphilis? I've tested negative for everything including Chlamydia, Gonorrhea, HSV 1/2, Hepatitis A/B/C, and HIV 1/2.
Thank you so much.
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Edward W. Hook M.D.
11 months ago
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The stories you’ve heard are the sort of misinformation that is all too common on the internet and Reddit. As one who has done syphilis research, written text book chapters, and advised the CDC and WHO on syphilis for over 40 years I’m quite confident in my advice.
Your risk of syphilis is very low. Testing at 6 weeks will be at least 99% conclusive. At that time the only thing you need to test for is syphilis. You’re in the clear for other STIs.
EWH
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11 months ago
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Thank you Dr. Hook, I will get re-tested only for syphilis at the 6 week mark. I had a quick question regarding the type of test that was used to diagnosis me. I've heard that there are two common tests used to diagnosis syphilis including the RPR test and the treponemal test. From my understanding, the RPR test looks for antibodies, but not specific to syphilis while the treponemal test is specifically used for syphilis antibodies. This was the type of test used for my result: "RPR, Rfx Qn RPR/Confirm TP" which was non-reactive for both Result & Range/Units.
Does this mean that both a RPR test and a treponemal test was used in order to conclude my non-reactive result? If so, should that give me more assurance since I heard that the false negative rate for treponemal tests are relatively lower (1-3%) compared to RPR test (10 - 15%)? I've also heard that treponemal tests are more accurate for early potential infection than RPR tests. If not, should I go get specifically tested using the treponemal test this week?
I do have a new romantic partner I've been getting to know (have abstained from any sexual activity), but I wanted to know if this was something I should worry about and inform them in case.
Thank you so much.
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Edward W. Hook M.D.
11 months ago
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It's a bit frustrating that I cannot help you move forward from your unwarranted concerns about syphilis. Your risk of syphilis is less than your chance of getting struck by lightening even before any testing and now, with your 32 day test results your chances of having syphilis have become less than 1 in a million.
Like virtually all blood tests for infectious diseases is a 2 stage procedure. First a screening test is done. When done at a correct time, f that is negative for the disease, the person does not have it and there is no need for a 2nd test. If the test is done too early, there is a chance of a false negative test. There is virtually no chance that your test was falsely negative with respect to the lesion you noticed.
You have once again "heard" information that is incorrect. Both the treponemal and non-treponemal (RPR) tests have similar false negative rates if done too early with the treponemal tests becoming positive a day or two before the RPR following lesion appearance.. 10-15% false negative is incorrect and far too high. There are NO reliable data on the day-by-day positivity rates for persons who. like you, do not develop lesions. As I said earlier "..nearly, if not, all persons who acquire syphilis will have positive syphilis blood tests within 30 days, and certainly within 6 weeks of an exposure. "
In my exert opinion, there is virtually no chance that you have syphilis and abstinence from sexual activity is not needed,. I wish you could get by your unwarranted paranoia and move forward.
This completes this thread. I hope you will not feel the need to return with further internet based information and misinterpretations. EWH
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