[Question #11903] Syphilis
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11 months ago
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So to start this out, I was tested and positive for syphilis on Feb 1 with a titer of 1:32. I got adequate treatment with doxycycline for 2 100 mg day and night for a month. After proper treatment, I was beginning to become sexually active and on May 25th I had gone to a gay bathhouse where I had oral sex (both gave and received) from as little as 3 to at most 5 guys in total. I then had two other oral encounters on June 8th. After all this I began to get more serious with an individual and decided to get tested on July 1st where my titer was deemed 1:4 and was considered negative by my health care provider. I proceeded to have anal intercourse with said individual but it was only the tip inserted and oral sex as well. I went back to the doctor on Aug 27 and was deemed positive again with a titer of 1:16. I was prescribed doxycycline again for 2 100mg day and night for 2 weeks. My questions are as followed:
1. What is the likelihood that my negative result on July 1st was too soon to test positive for the oral encounters I had prior to getting tested? All the encounters were strictly oral ONLY, and I believe I only had swallowed cum from one of the few I had been with.
2. What is the likelihood of resurgence in my syphilis even after adequate treatment was taken place? I know I can get reinfected but can it just come back naturally?
3. Are the chances here greater that I had possibly gotten it from the individuals I had oral sex with vs the one individual I had anal intercourse with? I never had any symptoms nor any lesions or chancres that were visible. It is possible that they went unnoticed. From what I can recall, the bathhouse was dark and one individual felt as they had a rough bump that almost felt like a wart while I was performing oral. I never had any lesions or bumps after this encounter.
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11 months ago
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This is a follow up with my previous questions. My partner got his results back and tested negative for syphilis however was still advised to finish the 2 week 100mg twice daily.
4. Since testing negative, would he continue to test negative thereafter with adequate treatment? I understand I will be positive for life since I had the disease prior, but since he had not would that make him non-reactive in his tests? For reference he got tested June 30 and started treatment the same day.
5. Is syphilis contagious during the incubation time? I am assuming that we had sex during my incubation time which is why his results came back negative.
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11 months ago
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*He got tested AUGUST 30 not JUNE 30*
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Edward W. Hook M.D.
11 months ago
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Welcome to the Forum. To summarize,
1. Feb1, 2024 tested- RPR 1:32-treated with doxycycline for 1 month. I presume you had negative tests in the past
2. May 25 and June 8,2024- Sexually active, giving and receiving oral only
3. July 1, 2024 RPR 1:4 This is a good response to therapy. I agree with your doctor
4. Subsequent anal intercourse, oral sex
5. August 27- RPR increased to 1:16 -retreated with doxycycline for 2 weeks
Synthesis. Following your initial treatment, you had a good response to therapy. Sometime between July 1 and August 27 however your RPR increased significantly and thr that reason, appropriately, you were re-treated with 2 weeks of doxycycline. This may have been a treatment failure or may have be a re-infection from another partner. It is appropriate for your regular partner (and others since July 1) to be treated preventatively, even with a negative RPR, and 2 weeks of doxycycline should be effective prevention. Preferred treatment is an injection of long acting penicillin but it is in short supply. Doxycycline as an effective alternative as long as it is taken as prescribed.
Thus in response to your specific questions.
1. Your July test was not too soon and at that time you had responded well to treatment
2. It's tough to tell whether this was a re-infection or treatment failure. Either way, you've been appropriately treated
3. Hard to say where your re-infection, if that is what is is, came from. The "rough bump" is a bit suspicious. Persons are statistically more likely to get syphilis from rectal intercourse than oral sex
4. Your partner is being treated appropriately and should complete the course of therapy
5. Syphilis can be prevented if treated during incubation period, For that reason treatment is recommended
Hope this information is helpful. EWH
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11 months ago
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I appreciate your response. I am just trying to put my mind at ease and get some answers that I have been wanting. The "small bump" was during the May 25th encounters and would be about 94 days out from when I tested positive. My follow up questions are as followed:
1. I understand that syphilis has a range from 10-90 days of incubation. Could my July 1st test be during the incubation time and therefore be negative?
2. I originally was tested to start my MTF therapy, and am grateful at that. I originally have my routine check up October 1st, would this be adequate time to get checked again? Around 19 days after I finish my course of medication.
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Edward W. Hook M.D.
11 months ago
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1. I'm not sure what you mean by incubation. It is difficult to know if and when you might have been re-infected if you were (as opposed to being a treatment failure). Given that you'd already been infected you could, I supposed have been re-exposed shortly (a few weeks, max) before you have your July 1 blood draw. Most experts believe that persons who acquired syphilis develop positive blood tests within 4 or at most 6 weeks after acquistion of infection- this period between acquistion of infection and development of a positive blood test is the "incubation period". The idea that the infection can incubate for up to 90 days before a blood test becomes positive is excessive and based on data nearly 100 year old.
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2. Not sure what you re referring to as MTF therapy. Retesting at about a month (Oct 1) after you initiated your 2nd round of therapy may be a bit early. Most would not expect to see a blood test response until 3-6 month.
You have one follow-up remaining
EWH
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11 months ago
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My last remaining questions are as followed:
1. Does the titer lever indicate how long I have had the infection? 1:32 was relatively high compared to 1:16 so I am uncertain if this can possibly show just how recent the infection could have come forth.
2. Is syphilis spread from lesions only, or can it be spread via the secretions of the anal lining or possibly pre-cum/semen? I would like to mention that I never visibly saw any chancres or developed symptoms to syphilis.
3. You mentioned that it takes 4 to at most 6 weeks for the disease to develop. With this in mind, would my July 1st test be considered conclusive? This would be 5 weeks and 2 days after the interaction with said "small bump" from May 25th & 3 weeks and 2 days after the interactions on June 8th.
4. This is somewhat of a follow up to my previous question. My partner was deemed negative on his August 30th test which was 5 weeks and 6 days from our interaction on July 20th. Would this also mean that his test would be considered conclusive?
5. Is there a possibility that this raise in titer level (1:4 > 1:16) could be a fluke or a false raise? Maybe due to some other outside factors unknown to me.
6. When I was taking my first course of doxycycline I remember being absolutely sick while on it. This time around I feel as the medication has not made me that way. Could this indicate I don't have any type of infection or is this an over shot?
I appreciate your time and I have also messaged my health care professionals to get down to the bottom of this. I am weighing in all my options as to me, personally, with my partner testing negative almost 6 weeks after our encounter I would like some clarity.
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Edward W. Hook M.D.
11 months ago
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As you know, we provide up to 3 responses to each client's questions. These replies will complete the thread. There should be no need to return to the Forum.
1. No, the titer does not reflect duration of infection. Titers are measured in what are called doubling dilutions so possible RPR titers, in sequence are 1:1, 1:2, 1:4, 1:8, 1:16. 1:32. 1:64 and upwards. 1:32 is just one step above a 1:16. Meaningful changes, like the ones that triggered your re-treatment are 2 steps. Thus going from 1:4 to 1:16 is a meaning/significant increase warranting re-treatment.
2. Syphilis is typically spread by direct lesion contact and probably not in secretions
3. Syphilis activity is measured by changes in the RPR titer. Following from reply no. 2 above, for your RPR to have gone from 1:32 to 1:4 is a meaningful response to treatment, indicating that you had responding to therapy. At that time you had responded to therapy and there was not yet evidence of a need for further treatment
4. Sigh, I think you are trying to use terms that just don't fit. Your partner was treated preventively as this was the safest course of action for him
5. It is possible that there was a lab error but your health care provider has been managing you in a conservative fashion with your and your partner's best interests in mind.
6. No it does not.
This will be my final response. Syphilis is a complex illness which in nuanced and takes considerable training to manage. Your health care provider has done a good job for you and I would encourage you to take further questions to him/her. There is little to be gained by what if' questions. Returning to this forum is unlikely to yield more information or clarity. EWH
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