[Question #1871] Congenital probability follow up question.

44 months ago

Hello again Doctors,

sorry to bother you again but as my paediatrician is still worried about my kid “very mild right lobe enlargement” I’m not getting completely calm. I’m going to use my second opportunity to ask a further couple of questions before taking further action.

1)      1) Is there any kind of test that can effectively rule out past, treated syphilis infection? ( I’m afraid I already know the answer, but it would be nice to have confirmation one way or another )

2)      2) I was surprised about how confident Doctor Hook was about my case. I feel like I’m missing something out. So, to be more precise, would be such an unlikely event to be cured of syphilis accidentally by having one week of amoxicillin and then test negative on a treponemal test about few months to one year later?

 

Thanks for your time again.

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome back to the Forum.  I'm sorry that you continue to worry that your misstep prior to the birth of your child may have results in congenital syphilis and be the explanation for your child's continuing health problems.  I'll start by re-posting the initial comment I made to you during our initial exchange, then expand a bit.

"I'll try to help.  Parents frequently worry if they are to blame when their children become sick and I suspect that the combination of your guilt over your contact out of marriage and your child's illnesses have led you to be concerned about syphilis.  I wish to reassure you that your child's illnesses are not due to syphilis but are simply unfortunate coincidences.  I say this with confidence because of the many ways that syphilis might have been detected in you or your wife (when she was tested during pregnancy) long before now.  While no test is perfect, the chance that syphilis would have be missed in you when you had no symptoms, when your blood was tested at the time of blood donation and when your wife was tested during pregnancy is zero.  Further neither pyloric stenosis nor accessory spleens are associated with syphilis and both ear discharge and splenic enlargement are non-specific findings with many causes other than syphilis."

First, consider simple statistics.  Syphilis is a rare disease, it occur predominantly among men who have sex with men, it is readily treated with penicillin medications and is readily detected with treponemal blood tests which remain positive lifelong- even after treatment, including the treponemal tests that you and/or your wife had had in the past.  For the disease to have been missed that many times and in so many ways puts the probability that your child's problems are due to syphilis at less than 1 in millions and millions.  It is just not reasonably within the realm of possibility.

As for your specific follow-up tests:
1.  Treponemal tests are often positive lifelong and are the best way to rule out possible past infection.  On rare occasions when the infection is detected and treated very early treponemal tests can become negative but this is quite rare.

2.  Please see above,  My assessment has not changed.  the combination of low probability and negative tests that both you and your swife have had just makes syphilis not a realistic possibility.  Really.  While I applaud your concern for your child, I can assure you, syphilis is not the cause of his health problems.  EWH

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44 months ago
Thanks for your conforting answer, doctor. I guess this should relax me completely.


Just a last question that I think would help me to see answered by you. 

Most sources, even from very prestigious institutions, tell the readers that the treponemal tests remain positive for life.
But then there are quite a few papers, which are highly cited ( yes, I deal with science papers regularly in my work , thing that has been very detrimental for me in this situation ), who report significant rates of complete seroreversion of treponemal tests, sometimes even in patients in the early latent stage. Some of this papers even warn explicitly against believing that treponemal test once positive remain always positive. I wonder about this discrepancy. Is the everyday experience of expert physicians like you what contradicts this findings that have worried me so much?

Thank you so much for your time.






Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
I think you are being a bit argumentative and paranoid.  With all due respect, I have to disagree with you.  I know of no high quality, carefully performed studies or papers which suggest that treponemal tests revert to non-reactive following syphilis treatment.  This is well known to occur in a minority of persons with primary syphilis and VERY rarely in patients with more advanced stages. 

Further, and equally important, I recommend that you consider my response (as well as that of your own doctors who clearly are not worried about congenital syphilis) in its entirely rather than trying to argue minor points.  Nothing you have written raises ANY fact-based concern that you, your wife, or your child acquired, transmitted or suffer from syphilis acquired through your prior low risk misstep.  To continue to perseverate on this possibility will not change my opinion or advice, nor will it help you or your child.  I say this out of concern for you, nothing more.  EWH
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44 months ago
You are probably right.

Sorry about that.

Again, thanks for your time and advice.

43 months ago
I think I'm about to get completely relaz. So I'll use up my last follow up question.

The reasoning would be like that: The probability of all the following events happenning at the same time:

- not having symptoms myself,
- not having symptoms my wife,
- being cured incidentally by the amoxicillin,
- being in the minority of people who test negative with treponemal tests after being cured,
and
- my wife becoming negative  in RPR in something more than a year after infection,
 
Is so low as to not worry a lot about it? Is that so?

Thank for your patience.

And let me apologize if I had been rude before. I'm having a pretty hard time. If it was me who can resolve this with a test I would be resolved by now. Besides, I'm hitting myself for not having done a syphilis test at the time. People of my generation don't event know what syphilis is; too scared of HIV.

Thanks again. You are being of great help in this difficult times.

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Yes, your summary is correct- the probability of each of the situations you have listed above occurring together is effectively zero and to worry about it is neither realistic nor an effective use of your time.  I understand that sometimes, particularly when our children are involved, our fears and imagination can get the best of us.  I hope my responses have helped you to avoid that. It is now time for you to move forward without further concern about syphilis (or other STIs) related to the encounter you described.

As this is my 3rd reply to your questions, this thread will be closed later today.  Take care.  EWH
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43 months ago
Hello Doctor
Thank you for your answers. They are very helpful and have put my mind at ease. I have one other question that is related to my cold sore.

This past weekend, beginning on Thursday all the way through Sunday, I was with my romantic partner (we live apart). We had sex many times over the weekend. I began noticing my coldsore on Friday or Saturday (I can't be sure which). Of course, once I noticed my cold sore I no longer performed oral sex on my partner. However, I'm worried that she may still have been at risk of contracting HSV1. I would not be surprised if throughout the weekend some of my spit came into contact with my partners genitals, even after I noticed the cold sore.

I asked her if she ever had coldsores before and she said she thinks she did when she was younger. But I can't entirely remember what she said and it seems she may not know. 

I'm not sure how best to proceed. I plan on talking to her tonight about the situation and hopefully I will have some answers for her. From what I understand, if she got coldsores before in her life (HSV1) then she is not at risk of contracting HSV1 from me, either orally or genitally. I believe I read that if someone had Oral HSV1 before then they cannot subsequently get genital HSV1. I would also like to know what the risk of transmission would be if she had not ever had HSV1 and I performed oral sex on her with a developing cold sore. Again, once I noticed the cold sore I did not perform any oral sex but im sure the cold sore was in the process of emerging before I noticed it and I don't know how likely transmission (from my lips to her vagina) in this situation. Finally, IF HSV1 is transmitted from me to her, do HSV1 genital outbreaks tend to be less severe than HSV2 genital outbreaks? So if I did unfrotunately pass HSV1 from my lips to her vagina, would her future symptoms, outbreaks, complications be less than with HSV2? 

Thanks so much