[Question #3242] Syph testing etc.
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91 months ago
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4 years ago I had a risky encounter, and a few days after I developed a major rash on my chest and bag. I did however knew that if it was a syphilis rash I should have had a chancre first and thereafter a rash, and that the rash presented too fast after the encounter to have been indicative of syphilis.
Yet the timing of the rash was so peculiar. I therefore went to get a quick test - it was negative. In the meantime a girl i dated got a weird sore on her hand (with no apparent reason/injury). It was about 1,5 cm in diameter, very round and didn’t really hurt. So I got nervous that despite the negative quick test I might had infected her with Syphilis. I therefore did a new test (9-10 months after the encounter) - this time RPR and WR. It also came back negative.
BUT - could I theoretically have been infected with Syphilis, infected her, then the syphilis cleared up on its own in me (i have read that 1/3 of the cases do that) and therefore all the tests were negative?
I think the quick test was a treponemal test but i’m not certain (Alere Determine Syphilis TP). I have read that treponemal tests remain positive despite infection getting cleared.
So I guess that would possibly clear my suspicion, that I had a syphilis infection and then cured on its own (disregarding the possibility of a false negative)?
Also I would like to know if it is in any way likely that the RPR test 9-10 months after would be negative even if the infection had cured on its own?
Yet the timing of the rash was so peculiar. I therefore went to get a quick test - it was negative. In the meantime a girl i dated got a weird sore on her hand (with no apparent reason/injury). It was about 1,5 cm in diameter, very round and didn’t really hurt. So I got nervous that despite the negative quick test I might had infected her with Syphilis. I therefore did a new test (9-10 months after the encounter) - this time RPR and WR. It also came back negative.
BUT - could I theoretically have been infected with Syphilis, infected her, then the syphilis cleared up on its own in me (i have read that 1/3 of the cases do that) and therefore all the tests were negative?
I think the quick test was a treponemal test but i’m not certain (Alere Determine Syphilis TP). I have read that treponemal tests remain positive despite infection getting cleared.
So I guess that would possibly clear my suspicion, that I had a syphilis infection and then cured on its own (disregarding the possibility of a false negative)?
Also I would like to know if it is in any way likely that the RPR test 9-10 months after would be negative even if the infection had cured on its own?
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Edward W. Hook M.D.
91 months ago
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Welcome to the forum. I hope that the comments that I am about to make will relieve any concerns that you might have about having acquired syphilis from the risky encounter your took part in years ago. While very early in infection, just as the primary lesions (ulcers) can be negative, the time course of your (and your partner's) rash is not at all suggestive of syphilis and your syphilis test (the RPR) 9-10 months after the encounter would have been positive had you acquired syphilis. I am not familiar with the "WR" test you mention. When persons are in the secondary stage of syphilis (the stage when a rash is part of the disease), the RPR and other tests are uniformly positive.
You are also correct that once persons have syphilis, treponemal antibody tests do remain positive and that the Alere test is a treponemal test.
I would not worry at all about syphilis in the situation you describe and hope that my comments will help you to do this. EWH
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91 months ago
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Thanks for your reply!
One last thing though: rereading my first message I see that I left out an important detail (i shortened the message to comply with the requirements).
The first test i took (the quick test), wasn't taken at the time of the rash but 7-8 months after the encounter. So the question is whether I could have cleared up in those 7-8 months and tested negative?
I guess the baseline of your reply will be the same, but I thought it was important to mention.
One last thing though: rereading my first message I see that I left out an important detail (i shortened the message to comply with the requirements).
The first test i took (the quick test), wasn't taken at the time of the rash but 7-8 months after the encounter. So the question is whether I could have cleared up in those 7-8 months and tested negative?
I guess the baseline of your reply will be the same, but I thought it was important to mention.
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Edward W. Hook M.D.
91 months ago
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Thanks for the clarification. I had read your post to assume that you had tested just a few days after the encounter. The increased time interval strengthens my confidence that that test result was also reliable.The rapid test (the Alere) was a treponemal test. It would not have become negative, even is syphilis lesions had cleared. Thus your clarification should serve to strengthen your confidence that you did not have syphilis.
I hope this helps. Nothing you have described suggests any need for continuing concern about syphilis. Further, there is no medical need for further testing EWH
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