[Question #2516] Follow Question on RPR Testing

43 months ago
Hello Doctors,

Dr. Handsfield informed me that the three STD panel tests at 6 weeks, 4 months, and 6 months are conclusive from my last exposure. My new GF requested these tests since I have never been tested before.  My GF is obsessed with an exposure I had when I was 21 when I performed oral sex on a Caucasian stripper. I did not get my first panel test until the age of 25. I have been explaining to her that syphilis is rare and that a negative RPR test is proof that I did not catch anything. She keeps reading on the internet that my test was most likely a false negative. I am just looking for one additional response to show her that there is nothing to worry about. 

Thank you and I apologize for having to post again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back. But I can't do much except reassure you (perhaps more important, your gf) that your negative syphilis test is reliable. 

First, heterosexually transmitted syphilis is quite rare in Canada. Apart from a few population groups (e.g., if she was a Nunavut native) the odds any particular stripper had syphilis in the past couple of decades is very low. Second, although oral sex can transmit syphilis, it usually does not; even with an infectious partner, the vast majority of oral sex events would not transmit it. Third, you report no symptoms of syphilis. The large majority of penile exposures resulting in syphils cause obvious symptoms, i.e the chancre (ulcer) of primary syphilis at the site of inoculation, which is sort of hanging out there and easily visible. (When people acquire syphilis without symptoms, it's usually because the exposed site is hidden, e.g. in the rectum, vagina, etc.) Fourth, in the exceedingly unlikely event you caught syphilis, your current partner(s) are not at risk. Chronic syphilis can be an important health problem for the infected person, but except for occasional transmission by pregnant women to a fetus in utero, the disease is not otherwise transmissible after a year or so.

Finally, as noted above and in your other thread, the rapid plasma reagin (RPR) blood test is highly reliable. Perhaps your partner had read that the RPR can become negative over time. True, but that's generally because the infection was treated and cured. The RPR can become negative without without treatment, but usually does not, and if it happens, generally it takes many years. Even then, a negative RPR means the disease has been contained by the immune system and is not active.

So this is definitely nothing to worry about. Whatever your partner read online was dead wrong, or she badly misinterpreted something. You don't have syphilis.

I hope that clears it up. Let me know if anything still isn't clear.

HHH, MD

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43 months ago
That was a perfect response doctor.  Thank you for your time. 
43 months ago
I am from chicago so I am assuming it is still very rare. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I misread Caucasian and Canadian. Sorry! But yes, heterosexually transmitted syphilis is rare in the US except in select populations and geographic areas. In Chicago and most urban areas, syphilis in the past couple of decades has been dominantly a problem in gay men.---
43 months ago
Thank you for the clarification doctor. So i was correct in saying my Rpr is reliable even though i tested 4 years after the exposure? 

Thank you and I will not bother you any further.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Yes of course, completely reliable. Re-read my replies above.

That concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.
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