[Question #2930] new symptom: reconsideration.

42 months ago

Sorry to be here again; some people are just unlucky. The problem now is that a few days ago my wife told me her left eye was in pain, just out of the blue.  And off course this drove me again to syphilis and made me look at the data about sensitivity of treponemal tests after treatment. Given that I’m not an expert, I need some clarification and advice.

I’ve read some studies which report no seroreversions of treponemal tests in the year following treatment of patients suffering secondary syphilis and some that do report seroreversions. For example, in one much cited study, out of 183 patients tested with MHA-TP and FTA-ABS three patients had their treponemal test negative three years after treatment. In another one, a seroreversion rate of about 5% was found in syphilis treated patients in one year after treatment but no association with syphilis stage was found. And finally, one studying the TPPA after treatment found just one seroreversion in one secondary syphilis patient out of more or less one hundred patients. So, I conclude, a rate of seroreversions of patients treated in the secondary stage of about 1% would be a reasonable estimation.  Difficult, but no impossible. Is this a reasonable number?

So, trying to put lower number to the risk I infected my wife: Most CSW use condoms,but from the data, maybe about 1% will not use a condom with a new client; let’s say 1/10 of the csw who do this, have active syphilis; missing the chancre (1/10); seroreversion after treatment( 1%). That’s about 1 in a million. Very very difficult but not impossible.

Given my wife symptoms and this situation, should I come out and get my wife tested?

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome back to our Forum.  I'm sorry that you continue to worry that you could have caught syphilis without knowing it, transmitted it to your wife where her infection as well as yours infection went undetected,  inadvertently treated it while you were taking amoxicillin, sero-reverted to a negative treponemal test because of the treatment and that your wife now has ocular syphilis.  I think your estimates of the probabilities are far too high (remember, most syphilis now occurs in men who have sex with men, not heterosexuals, even if they are clients of CSWs.  For instance, the estimate that 10% of CSWs who do not use condoms have active syphilis is off by at lest a factor of 10 and your estimate does not include the FACT that the majority of persons exposed to a syphilis-infected person do not acquire syphilis. 

In addition, I would add that when syphilis effects the eye, the infection is typically painless.

In science we never say never because we discover new and very rare things on a regular basis.  On the other hand, based on your history and test results, I would estimate the risk of you having acquired syphilis and transmitted it to your wife as being no higher than your risk of being stuck by a meteorite falling from the sky.  It is very, very improbable.  OTOH, you clearly continue to worry about this possibility and as such, I worry that it may be impacting you and your relationship to your wife in a deleterious fashion.  If this is the case, perhaps the best way to address your guilt and resulting anxiety is to tell your wife and ask that she get tested.  Should you choose this path, please understand that you are choosing to do so not because it is likely that your infidelity gave your wife syphilis but because of your guilt over your actions.  I am very confident that she does not have symptomatic syphilis from the exposure you describe in your earlier question.  EWH
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42 months ago
So, more close to ten millions.

And most likely event less because before having the symptoms ( the rash and the tinnitus ) I was absolutely sure I didn't have sex in the period before taking the antibiotics. After them, first I began to worry about the possibility of  transmitting syphilis to my partner through kissing ( which I red is possible ). But after some time worrying, my mind began to doubt about the posibility of  having had sex and not remembering. I even discretely ask my wife and she remembered the long time without sex, as it was so rare. I guess this notion about kissing is just impossible, isn't it?

I'd like just to have a test as reliable as HIV test independently of any treatment. I guess that does not exist and I have to accept the incertainty of the treponemal tests, am I right?

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Even the tens of millions estimate is conservative but better.  The testing you have had (repeatedly is as reliable as HIV tests when you consider the fact that syphilis is many times more common than HIV. 

Further, I really do believe you would have remembered if you had sex.  Kissing is not a concern, either,

You should be confident that you do not have syphilis.  EWH
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41 months ago
Thanks, 
I guess 1 out of ten millions is not something to worry much about. 
Anyway, I wish I hadn't taken the amoxicillin. Now, I would be as sure about never having had syphilis as I am about never having had HIV.  Not being able to know conclusively that I have never had syphilis is the thing that worries me the most. That's what I was referring to in the comment about syphilis tests sensitivity tests in my previous post.

Given that a conclusive test for past syphilis does not exist, I think I'll have to deal with the uncertainty.

Thanks for your services and keep the good work. The people like me who grew up during the eighties are only aware about HIV and more work like yours is needed to avoid situations like mine. Thanks




Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Thanks for your thanks.  Once again, I think the odds that you acquired syphilis are so small as to really be insignificant.  I also think that syphilis tests are better than you give them credit for and that you are over-reading things that you may have seen on the internet.

This thread will be closed later today. Take care.  EWH
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