[Question #3357] Are the automated RPR and TPLA tests very reliable?

90 months ago

Symptoms

August 19/2017

- sex with condom, oral sex without condom (with a female).

After 2 Days

- Mild stinging at the tip of penis

After 1 week

- meatitis, urethritis, dysuria

After 3 Weeks

- Red lesion on groin, near penis, healed in 2-3 weeks.

Since September:

-Various rashes/pimples/lesions on legs, arms, chest. Rashes tend to disappear within minutes, hours or days, and are more numerous and more visible after showering. Lesions tend to persist for a several weeks and then change into brown spots that fade away over several months.

December:

- tiny fluid filled pimples on penis & a small red rash, resolved in 1 week

- Extreme headache, dizziness and neck pain for 2 weeks. Continue to have headaches, dizziness and strong sinus irritation since then.

- significant swelling and pain in jaw on the right side, resolved in 2-3 weeks

January:

- Small rashes on hands (palms and backside) that appear and disappear within minutes or hours.

February:

- Meatitis and urethritis begin to fade, rashes/lesions less frequent, continue to have strong sinus irritation.

Testing and Treatment

10.5 weeks post exposure:

- HIV (AG/AB), Syphilis (RPR), Chlamydia, Gonorrhea and 23 various micro-organisms: negative.

- Positive for HSV-1 (IGG 1.53) and Strep B: doxycycline and acyclovir = no noticeable effect.

22.5 weeks post exposure:

- HIV (AG/AB), Syphilis (automated RPR/TPLA, FTA-ABS IGM/IGG), Chlamydia, Gonorrhea and various micro-organisms: negative: 1g Azithromycin and cefixime 200mg 2x/day for 5 days. Meatitis and urethritis worsen during medicine but improve after finishing it.

Questions

Is it possible to have syphilis despite consistently negative test results?
Are the automated RPR and TPLA tests very reliable?
Isn’t the FTA-ABS IGM and IGG intended for children less than 1 year old?
I clearly have symptoms but testing is consistently negative. I'm scared and confused. Please advise the best course of action going forward.

H. Hunter Handsfield, MD

90 months ago

Welcome to the forum. Thanks for your confidence in our services. Please note that we recommend users choose unique usernames. As you can see if you look at a few other threads, another user who calls himself James is not in our good graces at the moment! It's best if the moderators don't have to worry that new questions are not repeats from the same user.

The symptoms you describe really don't sound at all like syphilis. And heterosexually transmitted syphilis is currently rare in most of the United States, and you used a condom -- so the exposure carried little or no risk for syphilis. Based on your exposure and symptoms, I would not have recommended syphilis testing at all. However, the results are proof you don't have it.

Those comments cover your questions in general terms, but to be explicit so there is no misunderstanding:

1. No, it is not possible to have syphilis in the face of these test results.

2. Yes, these tests are very reliable. Automation probably increases their reliability because of reduced chance of human error.

3. You have found misinformation on the web or misunderstood something you found. These tests are intended for use in patients of any age.

4. I'm not saying you don't have symptoms. Obviously you do. But as I said above, they are not suggestive of syphilis; and even if they were, the test results prove something else is the cause. If they continue and/or you remain concerned, see a doctor. But I am very confident they are not caused by syphilis or any other infection from the sexual exposure described above.

I hope these comments are helpful and reassuring. Let me know if anything isn't clear.

HHH, MD

---