[Question #13656] Continued Positive RPR

1 months ago

Hey Doctors - this is a continuation of #13305

Since the last post - I met with a dermatologist who was immediately certain what the lesion was. Biopsy showed it was Lichenoid Dermatitis with a negative Syphillis infection stain. This was all very reassuring. Since then I was tested again while traveling and had a negative Treponema Pallidum Ab CLIA on 10/27 (4 months since exposure). Again re-assuring.

Yesterday, I received another blood test from my home clinic - to check both RPR level since August and do a full panel. I have had no sexual encounters in the last 6 months. The RPR came back 1:16. This is shocking given that the last RPRs have gone: 1:4, 1:2, 1:4. I am waiting on the results of the treponomal test but my expectations (hope?) are that it is will be negative. I will report the results here but hoping to get this thread started as I am leaving for travel on Friday, 12/26.

1. What is going on here? Should I be concerned that my RPR is up 1:16? The 4x increase has freaked me out.
2. I had a cold about 4 weeks ago that I caught at a wedding - sinus pressure, one day of fever, and cough after recovering. I wasn't able to test for covid - however, multiple other people also caught the same thing. Could this cause the elevated RPR levels?

3. How should I approach my trip/traveling? I'm concerned if a condition is getting worse.

Thanks again

Edward W. Hook M.D.

1 months ago

Welcome back to the Forum. I’m sorry to hear of the increase in your RPR and the concern it has caused. That said, I anticipate that your treponemal test will once again be negative. As Dr. Handsfield explained, persons with false positive syphilis tests may have them permanently. I suspect this is the case. As a generalization a one dilution variation in RPR values ( i.e. from 1:2 to 1:4 for instance) is common and acceptable variation. When an RPR goes up 4-fold however it warrants further investigation as is being done. Increased titers of the sort you have experienced could result from lab error. Given your lack of recent exposures, prior ( unnecessary) treatment, and multiple earlier negative treponemal tests, I anticipate your pending one will again be negative. Why the titer “ bounced” is unclear although a repeat RPR showing a titer in the earlier value would suggest lab error.

In the interim:

1. See above. Sorry I don’t have a more definitive answer. I doubt this is syphilis for the reasons I mentioned.

2. Viral infections are certainly associated with falsely positive tests. It’s possible

3. Unless you’re feeling poorly, I would not delay your trip.

Hope this helps. Further tests will tell the story. EWH

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1 months ago

Thanks doctor - the ELISA test came back negative (0.1). I plan to get another RPR test done in the coming months when back from my trip.

1. Are there any specific symptoms to watch out for in the interim? Anything related to autoimmune disorders?

2. Apologies to change topics, but, with this experience, I'm effectively too anxious to engage sexually anymore. I plan to see a therapist for this - however, I would love to hear your general take on prevalence of STIs and general safety? Is it possible to be sexually active and 100% safe from STIs? Is limiting intercourse to only manual stimulation effective? Is it worth taking some of the new preventive medications?

Thanks again!

Edward W. Hook M.D.

1 months ago

Thanks for the follow-up information. I'm not surprised to hear that your treponemal test was negative. I hope it provides with a degree of peace and will allow you to move forward.

1. Although there is an association of false positive RPRs with autoimmune disorders, most persons with false positive RPRs do not have autoimmune disorders or other explanations. It's just a matter of bad luck.

2. Please don't let this bit of bad luck keep you from moving forward with a sexually healthy life and future relationships. Therapy is a good idea. In general, please remember, most persons do not have STI and most exposures do not lead to infection. Practice safe sex (ask your partners is they have STIs and when they were last checked) and use safer sex methods (condoms) with new partners.

EWH

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