[Question #13249] Positive Syphillis Test

1 months ago

This is a follow up from #13246

Tested positive for

RAPID PLASMA REAGIN (RPR) TITER: Result 1:4

1. How do I interpret this result? All I had was a possible chancre and got penicillin shot yesterday. How worried should I be?
2. I got a 5th generation HIV test at 16 days and it came back negative. I've been on PEP since 5th day after exposure. How confident can I be on that test? How worried should I be about HIV contraction from insertive oral now that I have confirmation of syphillis contraction.

Thanks doctors - anxiety at an all time high.

1 months ago

3. Sorry I forgot to include: what are next steps here? will my test ever go back to non-reactive?

H. Hunter Handsfield, MD

1 months ago

As Dr. Hook advised, deleting your initial question makes it impossible to fully evaluate your situation. However, your RPR result of 1:4 is consistent with newly acquired syphilis, but only if and when a confirmatory secondary test (such as a T. pallidum EIA or other traditional confirmatory test like TPPA or FTA-ABS) also is positive. One of these is done automatically whenever the RPR result is positive so you and your doctors should know that result very soon. Even if the confirmatory test is positive, conceivably it means you have had syphilis in the past. Maybe the deleted question included information about past testing -- too bad it's gone.

Having said all that, it certainly is possible you have newly acquired syphilis after all -- both because of the RPR result and because of the apparent opinion of the doctor who decided you should be treated with penicillin.

If you are confirmed to have syphilis, the answer to your closing question is yes: the RPR usually becomes negative after treatment of syphilis. Normal procedures will be to repeat the RPR 2-3 times over the next year, which also helps judge whether the treatment was successful. However, the confirmatory tests for syphilis usually remain positive for life.

Your negative HIV test is reassuring but not conclusive because you are on PEP. Conclusive testing for HIV cannot be done until at least a couple of weeks after completing PEP.

Given your likely syphilis diagnosis, all this should now be in the hands of the doctor or clinic treating you. The forum cannot help you further. Good luck to you.

HHH, MD

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1 months ago

Thanks doctor - sorry about the removed message. Please feel free to re-open it if that helps. I'll pay again to remove as needed.

The missing context: insertive oral with high risk individual. no vaginal, no anal, no kissing. no visible open sores or blood. obviously did not see inside the mouth and that is likely the cause

1. How effective would the penicillin shot be at 19 days? I'm worried about information online regarding systematic and neuro damage. Basically how safe would you feel at this point?

2. The reported not doing the TP-PA. Should I push them to do it?
The RPR is reactive; therefore, TP-PA will not be performed. Please refer to RPR Titer.

3. I have read in your forum (and Dr. Hook's advice on HIV) that there is no risk for HIV from insertive oral. With a confirmed contraction of syphillis now - does your opinion change? I have read syphillis increases the chance of contracting HIV - but I can't make sense of that is for the giver or receiver.

Apologies again - your responses help a lot with my anxiety.

1 months ago

sorry I forgot to add.

4. additional context was this exposure was in Thailand. Would that change the treatment you would administer for this?

H. Hunter Handsfield, MD

1 months ago

Deleted messages are not retrievable after a day or two. It's gone forever.

1. The treatment is 100% effective in curing newly acquired (primary) syphilis, assuming the right kind of penicillin and dose, i.e. benzathine penicillin G (Bicillin®) 2.4 million units. Geographic location makes no difference in treatment effectiveness.

2. In the US and most other industrialized countries, TPPA or other confirmatory test always is done for newly positive RPR. That it was not done this time suggests your RPR was previously positive. If so, it reflects past syphilis, not a newly acquired infection. However, I don't know if policies and routine lab procedures might be different in Thailand. Discuss with your doctor. If this was your first positive syphilis blood test, then yes: you definitely should request or insist on confirmatory testing. False positive RPR results are quite common.

3. It now is more likely you don't have newly acquired syphilis after all -- and that the clinic treated you as a precaution, not because they made a clear diagnosis of primary syphilis. But whether or not you acquired syphilis does not indicate higher risk of HIV from insertive oral sex.

This thread remains open for one more comment, and after that you will be blocked from any further forum questions about this exposure. I suggest you use it to clarify your past syphilis test results and the reason the lab didn't do TPPA or other confirmatory test at this time.

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1 months ago

Thanks doctor:

1. This helps my understanding. What is the likelihood of having ocular or neurosyphillis (treated on 19th day). I had read it can occur even within the first few days of exposure and can hide in CSF. How should I go about ensuring I don't have this? If I do have asymptomatic neurosyphilis in my CSF - would I see my RPR stay high/increase after the treatment?

2 It was lab error. I got a TPPA done and it came back non-reactive. I saw an infectious disease specialist today and they said it's likely the TPPA will not turn reactive for another couple weeks and that this would support a first time primary syphillis infection. Would you agree?

3. I am feeling some tightness in the left side of my face/neck. I'm trying to understand if this could be a symptom based on my exposures?

I apologies; I was trying to keep them relevant to testing I was doing. If this is my last post - could I please get your closing thoughts on risk given insertive fellatio exposure with a high risk individual (non venue based sex worker). No burning or swelling symptoms.

1. HIV - No Chance. It would be the first confirmed case in the history of medicine.

2. Hep B - No Chance. Titer confirmed immunity.

3. Hep A/C - virtually no chance. Having NAAT tests performed for Hep C.

4. HSV - no symptoms after 21 days. Very unlikely to have contracted new herpes virus.

5. HPV - possible but Gardasil 9 should cover me for most dangerous strains. How long would I expect until warts show up?

6. Gonorrhea/Chlamydia - test all negative.

7. NGU - no one has brought this up. What testing should I do to rule out asymptomatic NGU?

8. Syphillis - essentially confirmed. Will continue with treatment - related to #1 - how safe should I feel having treated it as this point?

Thanks you again for taking the time on all of this. It has meant the world and I will try to move on.

1 months ago

apologies adding one more -

- my lymphocyte draw was 1.29 k/ul - the quoted normal range is 1.3 - 3.6. How concerned about this should I be? Could this be related to the syphillis infection? Should it increase concerns for HIV?

H. Hunter Handsfield, MD

1 months ago

1,2. I respectfully disagree with the ID specialist. You do not have syphilis, but a false positive RPR, which occurs in up to 2% of all RPRs. Not having syphilis also fits with your near zero risk exposure, which perhaps the ID doc didn't take into account. In general, TPPA and other confirmatory tests turn positive BEFORE the RPR, not afterward. However, given that doctor's advice, you should indeed have repeat syphilis testing (both RPR and TPPA) in a couple of weeks. I am confident the results will be the same, especially a negative TPPA. Since you almost certainly do not have syphilis, you cannot have ocular or neurosyphilis.

3. This is an irrelevant symptom, but ask your doctor/clinic about it if you remain concerned.

Your summary statements 1-4 are correct. 5) HPV: warts are 90% protected by vaccination; they can show up anywhere from 6 weeks to a couple years after exposure. 6) You don't have gonorrhea or chlamydia. 7) Asymptomatic means no NGU is present; there is no test for asymptomatic NGU anyway. 8) Your statement is wrong: almost certainly you do not have syphilis and never did. But given the ID doc's opinion, it is reasonable to follow his advice for follow-up testing in a couple of weeks.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please note the forum does not permit repeated questions on the same topic or exposure, especially when compulsively anxiety driven as I would characterize yours. This being your third it must be your last on this exposure and your concerns about syphilis and other STIs. Excessive questions are deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

However, I'll make a deal with you: If retesting in a couple of weeks shows a positive TPPA after all, please start a new thread with that information and we will reimburse your posting fee!

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