I was exposed to syphilis in 2008, one week later Doctor presumptively prescribed antibiotics and subsequently I was tested at 3 months and 6 months both by RPR and both non-reactive.  I have been celibate since.  Fast forward to present day, 9 years later and I came across several references that advise to not consume alcohol within 24 hours of submitting blood for RPR test as can result in false negative.  (delmars guide to lab and diagnostic tests, Rick Daniels, Manual of lab & diagnostic tests Fischbach & Dunning III, Brunner&Suddarths 2nd edition ha ndbook, university of Rochester health encyclopedia).  I have never heard of any patient instructions to avoid alcohol for 24 hours prior to Syphilis test and in Fischbach reference they advise against food 8 hours prior due to potential for excessive chyle in blood in addition to alcohol..  Now clearly I am worried as I do recall if I had alcohol the night before which would compromise accuracy of tests.  Would appreciate your expertise on this information as well as what I do now? Since 9 years ago I believe RPR is not nearly as accurate so not sure retesting with that will give me much comfort and cannot seem to fund clinic or on line service that uses EIA or treponema first test....appreciate you counsel in this matter.

This is a new one on me. In my 40+ years in the STD business, including 25 years running one of the country's (and world's) most respected public health STD clinics and research centers, I have never heard of alcohol intake interfering with the RPR or any other blood test, for syphilis or any other condition. Certainly when I directed the Seattle-King County clinic, it was not the policy to ask about or to care whether our patients had been drinking prior to being tested. To my knowledge, no STD clinic or lab doing routine syphilis testing makes such a recommendaton. But to make sure, in response to this question I just did a quick search of the National Library of Medicine database of the world's medical literature. I cannot find a single scholarly scientific article that suggests this is a real problem.

Also, if your preventive treatment was a recommended one, especially an injection of benzathine penicillin, almost certainly it was effective in aborting syphils if you had been infected. So your negative RPR results all those years ago were reliable and you did not have syphilis at the time you were tested. If you remain concerned, you can have another syphilis blood test now (and to assuage your own anxiety, perhaps avoid alcohol for 24 hours before the test is done). I'm confident it would be negative.

Finally, if you decide to be tested, the result will be reliable. Most labs these days do EIA, not RPR, as the initial screening test. But an RPR also would be reliable. I don't know what you think you learned in your online research, but it is very rare to have active syphilis and a negative RPR test. Whatever test you have, the negative result will prove you don't have syphilis.

I hope this information is helptul. Let me know if anything isn't clear.

HHH, MD

Wow - first time question, I suppose you don't see those too often. In any event I am a bit stunned that those authors would put those comments/instructions in their textbooks without any scholarly scientific literature.  You are right I have never seen or heard of those instructions.  Your reply did put me more at ease though I thought I would share a bit more. I do a semi ok job of keeping medical copies/records so I went back to see if I could find what antibiotics were prescribed but could not find and she is not my doctor anymore. I THINK it was 1g of Azrithomycin and a course of doxycycline taken a week or so after exposure, I know for sure it was not penicillin.  I did not have symptoms. In my records searching I found two more full blood panels I think were part of a full physical and both included RPR and non reactive.  The dates of those panels found today indicated 2 and 2.5 years after exposure.  Interestingly it also noted the time of blood draw and it ranged from 11:30am to 4:00pm. I would not have drank during the day rather on the occasions I do drink it is a cocktail or two after work or wine with dinner the evening before so this would suggest that at least 18 -20 hours had passed.  With your counsel and my further research I am feeling better and since not much I can do now over the holiday weekend will just see if my mind will let it go.  If not then I will get another test next week.  As mentioned my preference would be for a specific treponema test first, still cannot find a lab/clinic with EIA but an on line test center that uses labcorp has a FTA-ABS option. Labcorp has documentation out that they are moving to the reverse process with RPR as confirmatory and feel,they feel this test is more accurate with late latent.  Any concerns with my plan?

(Oh also one mentioned no food for 8 hours due to chyle, I assume you have same feeling on that)

This was a very traumatic experience 9 years ago and it has been hard on me to relive it but so thankful to you to have this kind of direct access to you and your expertise.  Thank you so much!