[Question #13390] Late tests

1 days ago

Hello Doctors,

I am a 29-year-old male. In 2015&2018 I had several protected vaginal sex encounters and received some unprotected oral sex. I never considered STDs until 2019 when I got a full STD panel, including (HIV 4th gen, HSV 1/2 IgG, Hep A IgM, Hep B Ag, Hep C Ab, Gc/Chla Amp, RPR Flex Titer + FTA). All results came back negative. Don’t recall seeing chancres.

I repeated these tests 9 years later, but VDRL was used instead of RPR.

Are these results (from 4 to 9 years after possible exposure) conclusive, and no need for confirmatory test like tpha or is there a possibility I could have been in a late latent syphilis stage and the tests showed a false negative?

H. Hunter Handsfield, MD

1 days ago

Welcome to the forum. Thank you for your confidence in our services.

The HSV blood tests are never conclusive, in the sense that some infected people never develop positive blood tests. That's especially true for HSV1 (but that's usually not sexually acquired anyway). And negative gonorrhea and chlamydia testing does not detect past infections, so those negative results do not prove you never had gonorrhea or chlamydia. However, having never had symptoms (discharge from your penis, painful urination) it is unlikely you ever had either of them.

The results are definitely conclusive for syphilis, HIV, and hepatitis A, B and C: you never had any of them. The VDRL and RPR are equivalent tests. There is no such thing s late latent syphilis with false negative blood tests. In theory you could have had syphilis and it was cleared by your immune system, but that's very unlikely -- especially in view of the low risk sexual lifestyle you describe. There is no need for further testing for syphilis or anything else.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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1 days ago

Dear Dr. Handsfield,

Thank you for your detailed response. I have a few follow-up questions based on your answers:

HSV-2 Testing: Since HSV tests aren’t conclusive, how can I be sure I’m not infected with HSV-2? If I’ve had no symptoms or blisters in the past 10 years, can I confidently conclude that I was never exposed to it? Is there any chance the virus could activate later?
GC/Chla Tests: Does a negative result suggests that any potential past infections have been cleared from my body?
VDRL/RPR Tests: Could there be a risk of false negatives if the tests were done 4-9 years after possible exposure? Do the sensitivity of these tests decrease over time, particularly if syphilis went untreated or in the absence of symptoms?
Penile Bumps: I’ve noticed small reddish bumps between the glans and foreskin of my penis. Could this indicate an infection or underlying issue?

H. Hunter Handsfield, MD

1 hours ago

1. Absence of symptoms -- recurrent genital area blisters or sores -- is strong evidence you don't have HSV2. If you feel compelled to be more certain, you can still have a blood test. The combination of negative test plus no symptoms is very good evidence. The problem, however, is that the blood tests often give falsely positive results. But the bottom line is that there is no way to be truly 100% certain HSV2 is absent. It is rare for asymptomatic infeciton to "reactivate later".

2. Yes. Negative result means you don't have it at the time you are tested; and if you had it in the past, it is gone now.

3. Negative results prove active, transmissible infection is absent. If your compulsions require 100% proof you were never infected, you can ask for one of the newer EIA blood tests. If negative, they prove syphlis never was present. But given your sexual lifestyle, there is almost no chance you have it anyway and all this seems overkill. Negative VDRL/RPR mean syphilis will never reactivate, even if you were infecfted sometime in the past.

4. This doesn't sound abnormal, but that's all I can say. Ask your doctor next time you have a routine appointment.

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