[Question #13477] Returning for Guidance

1 days ago

Good Morning Doctors,

I’m returning from my last post a couple months ago with concerns. I have been experiencing symptoms for weeks which include transient sore throat, persistent white patches on my inner cheeks, stiff neck, and my skin has been very sensitive to the touch causing dermographism that comes and goes.

My primary concern is Syphillis. I have tested negatively with a RPR at 45,52,60,73, and 86 days post exposure.

1) I know the standard guidance here for conclusive is 6 weeks but weird things in medicine happen, do my series of tests absolutely definitively rule out Syphillis?

2) With the persistence of symptoms is there any value in retesting further out with RPRs or requesting a Trep specific.

3) I am not immunocompromised to my knowledge, is serconverting this late a real possibility?

4) Could RPRs repeatedly be falsely negative at these intervals with symptoms present?

Edward W. Hook M.D.

23 hours ago

Welcome back to the Forum. Thanks for your continuing confidence in our service. On this occasion your follow-up questions came to me. In preparing to respond I reviewed your recent interaction with Dr. Handsfield and agree with all that he said- your risk for syphilis from your casual encounter was quite low to start with and your initial RPRs provided strong but not entirely conclusive evidence that you did not acquire syphilis. Your subsequent testing proved that you were not infected. In response to your specific questions:

1) I know the standard guidance here for conclusive is 6 weeks but weird things in medicine happen, do my series of tests absolutely definitively rule out Syphillis?

Yes.

2) With the persistence of symptoms is there any value in retesting further out with RPRs or requesting a Trep specific.

Your symptoms are not particularly suggestive of syphilis. I see no need for further testing. There is far more experience with RPR tests than treponeme specific tests so I see little benefit with treponemal testing.

3) I am not immunocompromised to my knowledge, is serconverting this late a real possibility?

4) Could RPRs repeatedly be falsely negative at these intervals with symptoms present?

Falsely negative tests occur in rare instances but for them to occur repeatedly this long after a potential exposure is unheard of.

BE confident you did not acquire syphilis. There is no medical or scientific reason for further testing. It's time to put your concerns behind you. EWH

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22 hours ago

Thank you Dr. Hook for your timely response and expertise.

Just to put a bow on it, regardless of anything, test results repeated at these intervals are irrefutable evidence that infection did not occur?

I thank you for your time and this amazing service you guys provide.

Edward W. Hook M.D.

20 hours ago

Correct. Be confident that you did not acquire syphilis during the casual encounter you described. EWH---